血清游离轻链检测对寡分泌浆细胞病的诊断作用  

Significance of Serum Free Light Chain in the Diagnosis of Oligosecretory Plasma Cell Dyscrasia

作　　者：曹军皓 艾翠芳 任菲菲 黄前川 阎有功 

机构地区：[1]解放军武汉总医院检验科,湖北武汉430070 [2]湖北中医药大学研究生院

出　　处：《华南国防医学杂志》2017年第9期590-592,608,共4页Military Medical Journal of South China

摘　　要：目的探讨血清游离轻链(serum free light chain,sFLC)检测对寡分泌浆细胞病的诊断作用,以及寡分泌浆细胞病的临床和实验特征。方法采用高灵敏度的散射浊度法定量检测sFLC,结合病理学、影像学和临床资料,分析25例寡分泌型浆细胞疾病的患者实验室表现及临床特征。结果 24例患者有一项或多项免疫球蛋白水平降低(96%,24/25)。sFLC水平和比值异常率100%。25例患者中5例为心脏淀粉样变性,其余20例为肾脏淀粉样变性和轻链沉积病(light chain deposition disease,LCDD)。25例患者的血清/尿蛋白电泳均阴性,血清免疫固定电泳阳性率32%(8/25),尿免疫固定电泳阳性率16%(4/25),骨髓浆细胞比例平均1.5%。确诊前病程平均12.7个月。结论寡分泌型浆细胞病临床表现多样,一般常规实验室检查难以发现,易误诊,sFLC检测对该病诊断有重要意义,敏感度显著高于其它单克隆免疫球蛋白的鉴定方法。Objective To investigate the significance of serum free light chain（sFLC）in the diagnosis of the oligosecretory plasma cell dyscrasia,and summarize the clinical and laboratory features.Methods The characteristics of 25 patients with oligosecretory plasma cell dyscrasia were analyzed by high sensitivity scatter turbidity assay,combined with pathology,imaging and clinical data.Results Among 25 patients with oligosecretory plasma cell dyscrasia confirmed by pathology,5 of the patients were heart amyloidosis,the rest 20 were renal amyloidosis and light chain deposition disease,and 24（96.0%,24/25）accompanied with immunoparesis by the feature of one or more the immune immunoglobulin levels reduction.The abnormal rate of sFLC levels and ratios were 100%,no visible monoclonal bands were detected by serum/urine protein electrophoresis of these 25 cases,and that of the positive rate of blood and urine immune fixation electrophoresis were 32.0%（8/25）and 16.0%（4/25）,respectively.The mean bone marrow plasma cells was 1.5%（0.5%-7.5%）,the duration before diagnosis was on an average of 12.7 months.Conclusion The clinical manifestations of the oligosecretory plasma cell dyscrasia are variety and easily to misdiagnose,and the detection of sFLC is great significance for the diagnosis of the disease,which sensitivity of detection of monoclonal protein is significantly higher than that of other assays.

关 键 词：血清游离轻链 寡分泌型浆细胞疾病 原发性淀粉样变性 轻链沉积病 

分 类 号：R542.2[医药卫生—心血管疾病]