在自定义高危群体中M蛋白定量筛查多发性骨髓瘤及相关预后研究  

作　　者：蒋志勇[1] 俞方泉 罗信国[1] 章勇[1] 叶宝东[2] 

机构地区：[1]浙江省金华市人民医院,321000 [2]浙江中医药大学附属第一医院,310003

出　　处：《浙江临床医学》2024年第2期251-253,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省金华市科技计划项目(2020-4-046)。

摘　　要：目的探讨M蛋白定量检测在符合自定义高危群体中对多发性骨髓瘤的诊断及预后分层价值。方法纳入2020年6月至2022年12月就诊于本院所筛查出的200例符合自定义多发性骨髓瘤高危群体进行血清蛋白电泳M蛋白检测及血清游离轻链定量测定,记录入组患者血清蛋白电泳结果、血清游离轻链定量及κ/λ比值;阳性患者进一步完善检测确诊为多发性骨髓瘤,确诊患者再进一步行Fish检测评估预后危险分层,记录相关检测结果。结果200例高危群体中血清游离轻链比值异常共检出58例,血清蛋白电泳阳性检出39例,进一步确诊多发性骨髓瘤共34例;确诊患者血清游离轻链比值异常为34例,而血清蛋白电泳M蛋白阳性为27例,7例漏诊;免疫原位杂交(Fish)检测结果提示确诊患者血清游离轻链高比值13例中(>100或<0.01)有8例存在高危遗传学改变,其他21例有3例存在高危遗传学改变。而多发性骨髓瘤高危影响因素的多因素分析显示:女性、贫血、球蛋白异常、血肌酐升高是高危影响因素,符合本研究中自定义多发性骨髓瘤高危群体的诊断标准。结论血清游离轻链检测相较于血清蛋白电泳检测可以明显降低多发性骨髓瘤漏诊率,是高危人群检测筛查的有效手段,并且血清游离轻链高比值跟基因风险分层存在一定的正相关性,能在一定程度上反应其预后风险。Objective To investigate the value of M protein quantitative detection in the diagnosis and prognosis of multiple myeloma in custom high-risk groups.Methods From June 2020 to December 2022,200 high-risk groups of multiple myeloma screened in our hospital were included for serum protein electrophoresis M protein detection and quantitative determination of serum free light chain.Serum protein electrophoresis results,serum free light chain quantification andκ/λratio were recorded.The positive patients were further improved and diagnosed as multiple myeloma.The diagnosed patients were further evaluated by FISH to evaluate the prognostic risk stratification,and the relevant test results were recorded.Results Among the 200 high-risk groups,58 cases of abnormal serum free light chain ratio were detected,39 cases of positive serum protein electrophoresis were detected,and 34 cases of multiple myeloma were diagnosed by further examination.There were 34 cases of abnormal serum free light chain ratio,27 cases of positive serum protein electrophoresis M protein and 7 cases of missed diagnosis.The results of FISH test showed that 8 of the 13 patients(more than 100 or less than 0.01)had highrisk genetic changes,and 3 of the other 21 patients had high-risk genetic changes.In addition,multivariate analysis of the risk factors for multiple myeloma showed that female,anemia,abnormal globulin and elevated serum creatinine were the risk factors,which met the diagnostic criteria for the self-defined multiple myeloma risk group in this study.Conclusion Compared with serum protein electrophoresis,serum free light chain detection can significantly reduce the missed diagnosis rate of multiple myeloma.It is an effective means of detection and screening for high-risk groups,and the high ratio of serum free light chain has a certain positive correlation with genetic risk stratification,which can reflect its prognostic risk to a certain extent.

关 键 词：多发性骨髓瘤 血清蛋白电泳 游离轻链 高危因素 预后风险分层 

分 类 号：R733.3[医药卫生—肿瘤]