血清游离轻链用于多发性骨髓瘤及自身免疫性高球蛋白血症鉴别诊断价值研究  

Value of serum free light chain in differential diagnosis of hypergammaglobulinemia

作　　者：高莉[1] 赵丹丹[2] 刘红[3] 贾园[1] 樊春红[3] 王辉[3] 路瑾[4] 

机构地区：[1]北京大学人民医院风湿免疫科,北京100044 [2]徐州医学院附属医院血液科,江苏徐州221006 [3]北京大学人民医院检验科,北京100044 [4]北京大学人民医院血液科,北京100044

出　　处：《中国实用内科杂志》2013年第8期635-638,共4页Chinese Journal of Practical Internal Medicine

基　　金：北京市科技计划项目(Z111107067311070)

摘　　要：目的探讨血清游离轻链(sFLCs)及其κ型与λ型比值(κ/λ值)在高球蛋白疾病良恶性鉴别中的临床价值。方法收集2012年1—8月北京大学人民医院血液科收治的多发性骨髓瘤(MM)65例,选取同期就诊于风湿免疫内科的高球蛋白血症患者31例。采用免疫比浊法测定sFLCs。比较两组免疫球蛋白、sFLCs、κ/λ值水平。结果 MM患者sFLCs质量浓度显著高于自身免疫疾病组(P<0.05),良恶性疾病κ/λ值差异有统计学意义(P<0.05)。κ型MM患者κ/λ值鉴别良恶性疾病的ROC曲线下面积(AUC)为0.92,最佳临界点为2.18时,其所对应敏感度为71%,特异度为100%。λ型MM患者κ/λ值鉴别良恶性疾病的AUC 0.82,最佳临界点为0.48时,其所对应的敏感度为79%,特异度为87%。κ型MM患者高κ/λ组较低κ/λ组生存时间短(P<0.05),λ型MM患者高κ/λ组较低κ/λ组生存时间长(P<0.05)。结论 sFLC的κ/λ值对于鉴别高球蛋白疾病良恶性有较高的敏感度和特异度,且对于κ型MM低肿瘤负荷患者诊断效能更高。κ/λ值与MM预后密切相关。Objective To explore the clinical significance of serum free light chain（sFLC） levels and their κ/λ ratios in the differential diagnosis of hypergammaglobulinemia. Methods Sixty-five patients with multiple myeloma（MM） from the department of hematology and thirty-one patients with autoimmune diseases from the department of rheumatology were eligible for this research and the sFLCs were detected by immuno-turbidimetry. The levels of sFLCs and κ/λ ratios were quantitatively analyzed and the ROC curve was drawn according to the κ/λ ratios to find the best diagnostic differential point. The correction between κ/λ ratios and other B-cell active markers were also analyzed. Results The sFLCs levels were significantly higher in MM patients than in controls, and the κ/λ ratios in MM patients were statistically different from those in controls（P 〈 0.05 ）. The sensitivity was 71% and the specificity was 100% when the optimal cut-off point was set at 2. 18 in sFLC-κ MM patients and the area under cure was 0. 92 ;the sensitivity was 79% and the specificity was 87% when the optimal cut-off point was set at 0. 48 in sFLC-λ MM patients and the area under cure was 0. 82. The κ/λ. ratios were strongly correlated with survival （ P 〈 0. 05 ）. Conclusion The κ/λ ratios are of high specificity and sensitivity in the differential di- agnosis of hypergammaglobulinemia,especially for κ-type MM patients with low tumor burden. The κ/λ ratios are closely correlated with prognosis.

关 键 词：游离轻链 高球蛋白血症 多发性骨髓瘤 自身免疫疾病 

分 类 号：R446.11[医药卫生—诊断学]