血清游离轻链在多发性骨髓瘤诊断及疗效监测中的临床意义

Serum free light chains in the diagnosis and monitoring of patients with multiple myeloma

目的探讨血清游离轻链（sFLC）在多发性骨髓瘤（MM）诊断和疗效监测中的临床意义。方法采用免疫比浊法检测62例MM患者在疾病不同阶段sFLCκ与λ浓度，计算其比值。以35例慢性肾功能不全（CRF）患者及62名健康供血者为对照。结果健康对照组sFLC中 κ值（13．25±6．46）mg／L，λ值（18．39±11．42）mg／L； κ／λ比值0．97±0．64（范围0．33．1．61）。CRF患者sFLC值为（200．01±299．87）mg／L，λ值为（191．02±245．98）mg／L，显著高于健康对照组（t=-17．804、-16．894，均P〈0．001）；但κ／λ比值（1．11±0．29）在正常范围内。57例分泌型MM，新诊断IgGκ、IgAκ、IgDκ型MM患者的κ值范围16．20—35250mg／L，IgGλ、IgAλ、IgD入型MM患者的入值范围为15．70～4885mg／L。96．5％（55／57）患者存在κ／λ比值异常（〈0．5或〉1．5）。治疗后达缓解／平稳期κ、λ水平及κ／λ比值趋于正常。结论sFLC检测对于MM患者的诊断、治疗效果及疾病复发的监测较常规检测方法更为敏感。

Objective To evaluate clinical significance of serum free light chains （sFLC） in diagnosis and response to the therapies of patients with multiple myeloma （MM）. Methods sFLC （κ,λ and κ/λ ratio） were examed by immumoassay from 62 patients with MM at different stage. The results were analyzed associated with clinical data, and 35 cases of chronic renal failure （CRF） patients and 62 cases of healthy donors were taken as controls. Results Medium sFLC of normal K value was （13.25±6.46） mg/L, h value was （18.39＋11.42） mg/L; and κ/λ ratio was （0.97-＋0.64） mg/L （range 0.33-1.61）. sFLC K and h of CRF patients were （200.01±299.87） mg/L, （191.02±245.98） rag/L, significantly higher than that of the normal control group （t = -17.804, -16.894, both P 〈 0.001）, but the κ/λ ratio was at normal range （1.11±0.29）. K value range was at 16.20- 35 250 mg/L in newly diagnosed intact immunoglobulin MM patients with IgGK, IgAK and IgDK type. The range of h values was 15.70-4885 mg/L in IgGλ, IgAλ, IgDλ type, and κ/λ ratio was abnormal in 96.5 % （55/57） patients （〈0.5 or 〉1.5）. The κ,λ value and κ/λ ratio were close to that of the normal after remmision. Conclusion sFLC （ κ,λ and κ/λ ratio） are very good monitoring markers for MM.