血清游离轻链κ/λ比率对多发性骨髓瘤的诊断价值  

Diagnostic Value of Serum Free Light Chain Ratio in Multiple Myeloma

作　　者：苏倩倩[1] 周志刚[1] 童来根[1] 黄文娟[1] 陈思思[1] 吴文忠[1] Su Qianqian;Zhou Zhigang;Tong Laigen(Department of Hematology,Yixing People′s Hospital,Jiangsu 214200,China)

机构地区：[1]江苏省宜兴市人民医院血液科,214200

出　　处：《医学研究杂志》2018年第9期44-48,共5页Journal of Medical Research

基　　金：国家自然科学基金资助项目(31302107)

摘　　要：目的探究血清游离轻链κ/λ比率(sFLCR)对多发性骨髓瘤的诊断价值。方法选取103例多发性骨髓瘤患者。使用免疫比浊法检测所有人的血清游离轻链,计算出sFLCR,并将患者分为高比率组和低比率组;分析高比率组多发性骨髓瘤患者sFLCR与血清学指标的关系,进而评价sFLCR对多发性骨髓瘤的诊断作用。结果比较高比率组与低比率组多发性骨髓瘤患者的一般资料情况,发现两组年龄、性别、血清白蛋白和Ig G相差不大,差异无统计学意义(P> 0. 05),但高比率组患者的DS分期中Ⅱ和Ⅲ期人数更多,β_2微球蛋白、sFLCR(≥100或≤0. 01)和血肌酐也多于低比率组,差异均有统计学意义(P <0. 05);对有显著差异的相关因素进行线性回归分析发现,β_2微球蛋白(P=0. 020)和sFLCR(P=0. 011)差异更明显,为高比率组多发性骨髓瘤疾病的独立相关因素;对高比率组多发性骨髓瘤患者sFLCR与β_2微球蛋白进行相关性分析,结果 sFLCR≥100多发性骨髓瘤患者sFLCR与β_2微球蛋白呈明显正相关(r=0. 680),而sFLCR≤0. 01多发性骨髓瘤患者sFLCR与β_2微球蛋白呈显著负相关(r=-0. 709)。采用ROC曲线分析比较β_2微球蛋白和sFLCR诊断的准确性,β_2微球蛋白诊断多发性骨髓瘤疾病的ROC曲线下面积为0. 817,而sFLCR的ROC曲线下面积为0. 878。结论 sFLCR可定量、准确诊断高比率多发性骨髓瘤,因此可作为临床多发性骨髓瘤诊断的一个参考指标。Objective To investigate the diagnostic value of serum free light chain ratio in multiple myeloma. Methods One hundred and three patients with multiple myeloma were selected. The serum free light chain levels were examined by immune turbidimetric method and sFLCR were calculated. Patients were divided into high-rate groups and low-rate groups. Relationship between sFLCR of patients with multiple myeloma and serological indicators was analyzed. SO we could analyze the roles of sFLCR in the diagnosis of multiple myeloma. Results There was no significant difference in age, sex, serum albumin and IgG between high-rate and low-rate patients with multiple myeloma （ P 〉0.05）. But the number of patients with DS pathological stage Ⅱ and Ⅲ was higher in high-rate group, and β 2-microglobulin, sFLCR（≥100 or ≤0.01）and serum creatinine were also higher than those of low-rate group, （ P 〈0.05）, and the difference was statistically significant （P 〈0.05）. From the multiple linear regression analysis of relevant factors, we found that β 2-microglobulin （ P =0.020） and sFLCR （ P =0.011） was independently associated with high-rate multiple myeloma. From the analysis between sFLCR and β 2-microglobulin of high-rate multiple myeloma, we found sFLCR of sFLCR≥100 multiple myeloma was positively correlated with β 2-microglobulin （ r =0.680）, however sFLCR of sFLCR≤0.01 multiple myeloma was negatively correlated with β 2-microglobulin （ r =-0.709）. The ROC curve was used to compare the diagnostic accuracy between and sFLCR. Using ROC curve analysis, the area under the ROC curve of β 2-microglobulin was 0.817, and the area under the ROC curve of sFLCR was 0.878. Conclusion sFLCR can be quantified accurately diagnose high-rate multiple myeloma, which can be used as a reference for the clinical diagnosis of multiple myeloma.

关 键 词：血清游离轻链κ/λ比率 多发性骨髓瘤 免疫比浊法 诊断 

分 类 号：R733[医药卫生—肿瘤]