Ig同型转换及寡克隆蛋白条带在免疫固定电泳图谱中的形态特点及其对多发性骨髓瘤患者骨髓移植疗效评价的意义  

Morphological characteristics of immunoglobulin isotype switch and oligoclonal protein bands in immune fixation electrophoresis atlas and its significance to effect of bone marrow implantation in patients with multiple myeloma

作　　者：黄建玲[1] 黄木荣[1] 潘碧燕 刘绮婷[1] 周远青[1] 吕伟标[1] 李亚红[1] 

机构地区：[1]广东省佛山市顺德区第一人民医院检验科,528300

出　　处：《检验医学与临床》2016年第6期783-785,共3页Laboratory Medicine and Clinic

摘　　要：目的探讨Ig同型转换及寡克隆蛋白条带在免疫固定电泳（IFE）图谱中的形态特点及其对多发性骨髓瘤（MM）患者骨髓移植疗效评价的意义。方法选取2004~2014年本院收治的MM患者64例,比较患者行骨髓移植前后血清蛋白电泳及IFE图谱资料,并进行分析与统计。结果 64例MM患者中,48.4%出现Ig同型转换和（或）寡克隆蛋白条带。异常蛋白条带（APB）首次出现中位数时间为移植后1.8（0~29）月。血清IFE结果提示71.0%的患者首先出现的是IgG kappa同型转换,IgG lambda占9.7%,IgA kappa占3.2%,IgA lambda占9.7%,IgM kappa占3.2%,LC占3.2%。移植后首先出现是以IgG kappa同型转换为多见。出现APB的患者与非APB患者无进展生存率分别为43%和0,差异有统计学意义（P=0.049）;完全缓解率分别为86.7%和61.5%,差异有统计学意义（P=0.03）。至随访结束,31例APB患者与33例非APB患者比较5年生存期,分别为83%和57%,差异无统计学意义（P=0.12）。结论 MM治疗过程中出现APB往往提示疗效更高,预后更好。对MM治疗过程中新出现APB特点的解释及正确认识也将影响疗效评价的正确判断。Objective To study the morphological characteristic of immunoglobulin（Ig）isotype switch and oligoclonal protein bands in immune fixation electrophoresis（IFE）atlas and its significance to effect evaluation of bone marrow implantation in patients with multiple myeloma（MM）.Methods Sixty-four MM patients treated in our hospital during 2004-2014 were selected.The atlas data of serum protein electrophoresis and IFE in the patients with bone marrow implantation were compared between before and after implantation and performed the statistical analysis.Results Among 64 cases of MM,48.4% of cases had Ig isotype switch and（or）oligoclonal protein bands.The median time of the first appearance of abnormal protein band（APB）was 1.8 months after transplant（0-29months）.The IFE results demonstrated that 71.0% of cases had IgG kappa isotype switch as first appearance,IgG lambda accounted for 9.7%,IgA kappa for 3.2%,IgA lambda for 9.7%,IgM kappa for 3.2%and LC for 3.2%.After transplantation,first appearance of IgG kappa isotype switch was more common.The EFS rates in the patients appearing APB and non-APB were 43% and 0respectively,the difference was statistically significant（P=0.049）;the CR rates were 86.7%and 61.5%respectively with statistical difference（P=0.03）.Until the follow up end,in the 5-year OS comparison between 31 cases of APB and 33 cases of non-APB,which were 83%and 57%respectively without statistical difference（P=0.12）.Conclusion The APB appearance during MM treatment process often prompts higher curative effect and better prognosis.The interpretation and correct cognition of newly appeared APB characteristics also affect the correct judgment of the curative effect.

关 键 词：多发性髓瘤 Ig同型转换 寡克隆蛋白条带 M蛋白 免疫固定电泳 

分 类 号：R733.3[医药卫生—肿瘤]