血清游离轻链及肾脏相关小分子代谢物在多发性骨髓瘤合并肾脏损伤早期诊断中的应用  

Application of serum free light chain and kidney-related small molecule metabolite in early diagnosis of multiple myeloma complicated with renal injury

作　　者：李英 林志强[3] 尹佳锋 马燕粉[1] 杨波[1] 王晓琴[1] 

机构地区：[1]西安交通大学第一附属医院检验科,西安710061 [2]陕西省康复医院检验科 [3]新乡医学院第一附属医院检验科 [4]西安交通大学第二附属医院检验科

出　　处：《山西医科大学学报》2017年第10期1048-1052,共5页Journal of Shanxi Medical University

基　　金：陕西省国际合作与交流计划资助项目(2015KW-045)

摘　　要：目的分析血清游离轻链(FLC)、尿素(BUN)、肌酐(CRE)、尿酸(UA)、胱抑素C(Cys C)、血清总钙(Ca)及基于肌酐计算的肾小球滤过率估算值(e GFR)等指标在多发性骨髓瘤(MM)合并肾脏损伤早期诊断中的应用价值。方法收集193例确诊为MM的患者,检测其血清FLC水平及BUN、CRE、UA、Cys C等肾脏相关小分子代谢物水平,利用方差分析统计不同肾功能组患者间上述指标的差异,利用Pearson相关分析统计FLC与其他肾脏相关指标间的相关性,利用Logistic二元回归评估患者肾脏损伤的风险因素。结果 (1)患者FLCκ、λ、κ/λ及FLC差值(d FLC)的数据分布均为偏态分布,将其经过常用对数转化后则转为正态分布。(2)利用既往诊断及BUN、CRE、e GFR的检测结果判断为肾功能异常的患者,其血清Cys C、UA及Lg(FLCκ)、Lg(FLCλ)和Lg(d FLC)均显著高于肾功能正常的患者(P<0.01)。(3)BUN、CRE、e GFR、UA与FLC指标间具有统计意义上的相关性(P<0.05),且与经常用对数转化后的FLC指标间的相关性更高;而Cys C仅与Lg(FLCκ)相关(P<0.01)。(4)BUN、CRE、Cys C、UA、FLCκ、λ及d FLC均为MM患者发生肾脏损伤的危险因素(P<0.05),e GFR为保护性因素(P<0.01),其中Cys C的风险最高,而经常用对数转化后的FLCκ、λ及d FLC的风险均高于未经转化的原始值。结论监测FLC指标,尤其是Lg(FLC)和Lg(d FLC)的水平,及血清Cys C、CRE、BUN、UA等肾脏相关小分子代谢物水平对于预测MM患者发生肾脏损伤的风险及早期诊断MM肾损伤具有重要的临床意义。Objective To explore the diagnostic value of serum free light chain（ FLC）,urea nitrogen（ BUN）,creatinine（ CRE）,uric acid（ UA）,cystatin C（ Cys C）,total calcium（ Ca）,and estimated glomerular filtration rate（ e GFR） in early diagnosing multiple myeloma with renal injury. Methods A total of 193 patients with multiple myeloma were collected,and the serum FLC levels and other renal related makers,including BUN,CRE,UA,Cys C,were detected. The difference of the above makers between patients with different renal function was analyzed using variance analysis,the correlation between FLC and renal makers was analyzed using Pearson correlation analysis,and the risk factors of renal injury were further forecasted by Logistic binary regression. Results（1）The FLCκ,FLCλ,FLCκ/λ,and the difference of FLC（ d FLC） showed skewed distribution,and all these data showed normal distribution after converted by common logarithm.（2）The values of Cys C,UA,Lg（ FLCκ）,Lg（ FLCλ）,and Lg（ d FLC） were significantly higher in patients with abnormal renal function according to BUN,CRE,e GFR and previous diagnosis,than those in patients with normal renal function（ P 〈0. 01）.（3）The values of BUN,CRE,e GFR,and UA were correlated to FLC indexes（ P 〈 0. 05）,especially to common logarithm converted FLC indexes,and Cys C was only correlated to Lg（ FLCκ）（ P 〈 0. 01）.（4）BUN,CRE,Cys C,UA,FLCκ,FLCλ,and d FLC were risk factors of renal injury（ P 〈 0. 05）,while e GFR was the protective factor（ P 〈 0. 01）. In the above indicators,Cys C had the highest OR value,and OR values of the common logarithm converted FLC indexes were higher than those of un-converted data. Conclusion Monitoring the common logarithm converted FLC indexes,especially levels of Lg（ FLC） and Lg（ d FLC）,and serum renal makers of Cys C,CRE,BUN and UA have great clinical significance in predicting the risk of renal injury in patients with multiple myeloma and early diagnosing multiple myelo

关 键 词：多发性骨髓瘤 肾脏淀粉样变 血清游离轻链 肾损伤标记物 

分 类 号：R733.3[医药卫生—肿瘤]