血清游离轻链在慢性淋巴细胞白血病患者预后评估中的价值  

Value of serum free light chain in the prognosis evaluation of patients with chronic lymphocytic leukemia

作　　者：王慧[1] 王蓉[1] 谢而付 史晓姣 范磊[1] 乔纯[1] 仇海荣[1] 王琰[1] Wang Hui;Wang Rong;Xie Erfu;Shi Xiaojiao;Fan Lei;Qiao Chun;Qiu Hairong;Wang Yan(Department of Hematology,the First Affiliated Hospital of NJMU,Nanjing210029,China;Department of Laboratory Medicine,the First Affiliated Hospital of NJMU,Nanjing210029,China)

机构地区：[1]南京医科大学第一附属医院,江苏省人民医院血液科,南京210029 [2]南京医科大学第一附属医院,江苏省人民医院检验学部,南京210029

出　　处：《中华检验医学杂志》2025年第1期142-148,共7页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨血清游离轻链在慢性淋巴细胞白血病(CLL)患者预后评估中的价值。方法回顾性队列研究。纳入南京医科大学第一附属医院2014年1月1日至2020年12月20日156例初治CLL患者,其中男106例,女50例,年龄60.7(53.4,66.0)岁。采集患者血清,检测血清游离轻链,并根据是否存在治疗指征,将患者分为治疗组(106例)和随访组(50例),通过说明书参考范围及ROC曲线界定血清游离轻链(sFLC)的阈值,使用血清游离轻链比值(sFLCR)、血清游离轻链之和[sFLC(κ+λ)]及受累与未受累游离轻链的差值[sFLC(κ-λ)]3个指标,将患者分为sFLCR正常组(n=61)与异常组(n=95)、sFLC(κ+λ)低值组(n=88)与高值组(n=68)、sFLC(κ-λ)低值组(n=64)与高值组(n=92)。异常组与高值组作为实验组,正常组与低值组作为对照组,采用卡方检验和Fisher精确检验比较实验组与对照组患者的临床资料、细胞遗传学及分子生物学特征,Kaplan-Meier分析患者的中位无治疗生存期(TFS),Cox回归筛选影响患者的预后因素。结果sFLCR、sFLC(κ+λ)、sFLC(κ-λ)的实验组在Rai分期Ⅰ~Ⅳ比例(χ^(2)=8.16,P<0.05和χ^(2)=7.63,P<0.05和χ^(2)=5.45,P<0.05),Binet分期B~C比例(χ^(2)=4.11,P<0.05和χ^(2)=9.43,P<0.05和χ^(2)=7.34,P<0.05),β2微球蛋白>3.5 mg/L比例(χ^(2)=5.13,P<0.05和χ^(2)=18.3,P<0.05和χ^(2)=12,P<0.05),ATM基因突变率(χ^(2)=6.21,P<0.05和χ^(2)=4.88,P<0.05和χ^(2)=5.19,P<0.05)及免疫球蛋白重链可变区(IGHV)无突变率(42.3%)(χ^(2)=18.9,P<0.05和χ^(2)=24.6,P<0.05和χ^(2)=10.4,P<0.05)均高于对照组。多因素分析结果显示,sFLC(κ+λ)(HR=1.615,95%CI 1.012~2.576,P=0.044),β2微球蛋白(>3.5 mg/L)(HR=2.103,95%CI 1.356~3.262,P=0.001)及TP53缺失和/或突变(HR=1.892,95%CI 1.082~3.308,P=0.025)是影响患者首次治疗时间(TFT)的独立危险因素。结论血清游离轻链比值异常及轻链之和与差值的增高可预测早期治疗的风险,在初治CLL患者中具有较好的预后判断意义。ObjectiveTo explore the prognostic value of serum free light chain in chronic lymphocytic leukemia patients.MethodsRetrospective cohort study was conducted.One hundred and fifty-six newly diagnosed chronic lymphocytic leukemia(CLL)patients in the first affiliated hospital of Nanjing Medical University from January 2016 to December 2020 were included in the retrospective analysis.Among them,there were 106 males and 50 females,with a median age of 60.7(53.4,66.0)years old.Serum sample was collected,serum free light chains were detected,and patients were divided into a treatment group(106 cases)and a follow-up group(50 cases)based on the presence of treatment indications.The threshold of serum free light chain(sFLC)was defined by the reference range of the instruction manual and ROC curve.Three indicators were used,including sFLCR,sFLC(κ+λ)and sFLC(κ-λ).Patients were divided into normal sFLCR group(n=61)and abnormal group(n=95),as well as sFLC(κ+λ)low value group(n=88)and high value group(n=68),and sFLC(κ-λ)low value group(n=64)and high value group(n=92).The abnormal group and high value group were enrolled as the experimental group,while the normal group and low value group were enrolled as control group.Chi-square test and Fisher′s exact test were used to compare the clinical data,cytogenetics,and molecular biology characteristics of patients in two groups,Kaplan-Meier method was used to analyze the median treatment-free survival(TFS)of the patients,and Cox regression was used to screen the prognostic factors of the patients.ResultsThe proportion of Rai stageⅠ-Ⅳ(χ^(2)=8.16,P<0.05 andχ^(2)=7.63,P<0.05 andχ^(2)=5.45,P<0.05),Binet stage B-C(χ^(2)=4.11,P<0.05 andχ^(2)=9.43,P<0.05 andχ^(2)=7.34,P<0.05),β2-microglobulin>3.5 mg/L(χ^(2)=5.13,P<0.05 andχ^(2)=18.3,P<0.05 andχ^(2)=12,P<0.05),ATM gene mutation rate(χ^(2)=6.21,P<0.05 andχ^(2)=4.88,P<0.05 andχ^(2)=5.19,P<0.05),and immunoglobulin heavy chain variable region(IGHV)mutation free rate(χ^(2)=18.9,P<0.05 andχ^(2)=24.6,P<0.05 andχ^(2)=10.4

关 键 词：白血病 淋巴细胞 慢性 B细胞 血清游离轻链 预后 

分 类 号：R733.72[医药卫生—肿瘤]