摘要
目的探讨血清免疫固定电泳和血清轻链比值测定在以肾脏损伤为首发症状的多发性骨髓瘤(MM)患者中用于实验室诊断与鉴别诊断的价值。方法肾脏疾病患者共822例进行血清免疫固定电泳、血清轻链测定及免疫球蛋白定量,同时检测患者肾脏功能,包括尿素(BUN)、肌酐(Crea)、胱抑素C(Cys-C)以及估算肾小球滤过率(eGFR)。分析血清免疫固定电泳和血清轻链比值测定在诊断和鉴别诊断原发性肾脏损伤疾病以及MM继发肾脏损伤疾病中的临床应用价值。结果 822例患者中9.1%(75/822)患者出现M蛋白。其中IgG型49.3%(37/75),IgA型34.7%(26/75),IgM型5.3%(4/75),单纯轻链Lambda(LAM)10.7%(8/75)。Kappa(KAP)/LAM比值在M蛋白组和非M蛋白组间比较差异有统计学意义,以KAP型轻链表达为主的M蛋白组高于非M蛋白组、以LAM型轻链表达为主的M蛋白组低于非M蛋白组(P均<0.001)。M蛋白组患者与非M蛋白组患者间比较,Crea、BUN、Cys-C以及eGFR检测结果差异均无统计学意义。单纯LAM轻链组与IgG型组、IgA型组和IgM型组比较,Crea检测值增高,而eGFR值降低(P均<0.05)。结论免疫固定电泳和血清轻链KAP/LAM比值检测在MM合并肾功能不全中具有重要辅助诊断价值,是早期筛查的重要实验室指标之一。
Objective To explore the diagnostic value of immunofixation electrophoresis and Kappa/Lambda（KAP/LAM）ratio in multiple myeloma patients with renal injury.Methods The serum of 822 patients of renal disease were collected for the examnation of immunofixation electrophoresis, KAP/LAM ratio, serum immunoglobulin levels and renal function,including serum urea nitrogen（BUN）,serum creatinine（Crea）,cystatin C（Cys-C）and estimated glomerular filtration rate（eGFR）.To analyze the diagnostic value of immunofixation and KAP/LAM ratio in the differentiation of renal injury of multiple myeloma from primary renal injury diseases.Results M protein was observed in 75patients（9.1%）.The ratio of each type was IgG 49.3%（37/75）,IgA34.7%（26/75）,IgM 5.3%（4/75）and LAM 10.7%（8/75）.There was significant difference of KAP/LAM ratio between M protein group and non-M protein group.The KAP/LAM ratio was significant higher in KAP group,compared to non-M protein group.Reverse result was obtained in LAM group.There were higher Crea level and lower eGFR value in pure LAM light chain group,compared with IgG,IgA and IgM groups.ConclusionImmunofixation electrophoresis and KAP/LAM ratio may play an important role in the diagnosis of multiple myeloma patients with renal injury,so could be early screening markers.
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2016年第4期551-555,共5页
Journal of Sichuan University(Medical Sciences)
关键词
多发性骨髓瘤
肾脏损伤
免疫固定电泳
血轻链
Multiple myeloma
Renal injury
Immunofixation electrophoresis
Light chain
