4种电泳及轻链定量在多发性骨髓瘤诊断中的应用被引量：1

Clinical application of four kinds of electrophoresis and quantification of serum light chain in dignosis of Multiple Myeloma

原文传递

导出

摘要目的探讨4种电泳筛查多发性骨髓瘤（multiple myeloma,MM）及其分型的价值。方法收集我中心164例MM患者作为病例组（MM患者组）,同时收集45例健康体检者作为对照组（非MM组）,所有研究对象均采集血液和尿液。用血清蛋白电泳（serum protein electrophoresis,SPE）和高分辨尿蛋白电泳（high resolution urinary protein electrophoresis,HR）分别对所有研究对象的血液和尿液样本进行M蛋白筛查,然后用血清免疫固定电泳（immunofixation electrophoresis,IFE）和尿本周氏蛋白电泳（Bence-Jones protein electrophoresis,B-J）对所有研究对象进行分型;并用罗氏生化仪检测所有研究对象的血清总蛋白（total protein,TP）、白蛋白（albumin,ALB）、球蛋白（globulin,GLOB）、免疫球蛋白（immunoglobulin,Ig）及轻链定量,并计算轻链比值。结果 SPE和HR对164例MM患者M蛋白的检出率分别为92.68%和59.76%,IFE和B-J的检出率分别为98.17%和59.76%。45例非MM组经4种电泳均未检出M蛋白。与非MM组相比较,MM患者组的TP、GLOB、轻链κ、λ含量显著升高,差异有统计学意义（t=34.968,38.231;F=72.811,58.611;P〈0.05）。轻链型患者HR、B-J的阳性率明显高于IgA型患者、IgG和IgM型患者,差异具有统计学差异（χ^2=6.870,13.236,19.725;P〈0.05）。结论 IFE是MM诊断最敏感的检测方法,使用多种电泳方法结合免疫球蛋白及轻链定量同时检测,可以明确分型,有效避免漏诊、误诊,为临床全面评估病情提供依据。 Objective To investigate the value of 4 kinds of electrophoresis and quantification of serum light chain in diagnosis and typing of multiple myeloma （MM）. Methods The serum and urine of 164 cases of multiple myeloma patients and 45 healthy adults （control group） were collected. American HELLENA agarose gel electrophoresis technique was used for Serum immunofixation electrophoresis （IFE）, serum protein electrophoresis （SPE）, Bence-Jones protein electrophoresis （B-J） and high resolution urinary protein electrophoresis （HR）. The levels of immunoglobulin （IgG, IgA and IgG）, total protein （TP）, and albumin （ALB）, globulin （GLOB） and light chain on both groups were measured by Roche biochemical instrument. Results In 164 cases of MM patients, the detection rate of the M protein in SPE was 92.68%, the detection rate of the M protein in IFE was 98.17%, the detection rate of the M protein in B-J was 66.46% and the detection rate of the M protein in HR was 59.76%. M protein was not detected in the electrophoresis of the healthy control group. Compared with the healthy control group, MM patients＇ content ofTP, ALB, IG, light chain κ, λ was significantly increased （t=34.968, 38.231; F=72.811, 58.611; P〈0.05）. HR and B-J＇s positive rates of light chain patients were significantly higher than that of lgA, IgG and IgM patients （x^2=6.870, 13.236, 19.725; P〈0.05）. Conclusions IFE is the most sensitive detection method for MM diagnose. Combination of a variety of electrophoresis methods and simultaneous detection of immunoglobulin and light chain quantitative detection can effectively avoid missed diagnosis and misdiagnosis. The methods provide evidence for comprehensive assessment of the disease on clinic.