血清克隆性免疫球蛋白检查在慢性淋巴细胞白血病患者中的预后价值

Prognostic significance of serum immunoglobulin paraprotein in chronic lymphocytic leukemia

目的研究血清克隆性免疫球蛋白（Ig）在慢性淋巴细胞白血病（CLL）患者中表达以及与CLL预后指标的相关性，探讨其在CLL患者预后中的意义。方法全自动电泳仪及扫描仪分析并记录患者血清蛋白电泳和免疫固定电泳结果，定性Ig重链及轻链类型。利用速率散射比浊法定量测定Ig表达水平。结果101例CLL患者中20例（19．8％）存在克隆性Ig，克隆性IgG、IgM和IgA的检出率分别为13例（12．9％）、7例（6．9％）和1例（1．0％），其中1例（1．0％）患者存在克隆性IgG和IgM双克隆，2例（2．0％）患者共表达轻链K、入。在Binet晚期和血清胸苷激酶1（TKl）高水平组，血清克隆性IgG发生率明显高于Binet早期组（P=0．032）和TKl正常水平组（P=0．013）。同时发现，Bi—net晚期组、TKl高水平组和间期荧光原位杂交（FISH）del（11q22．3）阳性组中，血清克隆IgM发生率分别高于Binet早期组（P=0．037）、TK1正常水平组（P=0．017）和FISHdel（11q22．3）阴性组（P=0．006）。中位随访30（1—101）个月，66例患者诊断后接受化疗，统计发现血清克隆性Ig阳性组患者的无治疗生存（TFS）时间（2个月）较阴性组患者（15个月）短（P=0．024），其中血清克隆性IgM阳性组患者的中位TFS时间（1．5个月）较阴性组患者（15个月）短（P=0．013），但Ig和IgM阳性不是独立的预后因素。结论部分CLL患者血清中存在克隆性Ig，血清克隆性Ig可成为判断CLL患者预后的指标。

Objective To investigate the incidence of serum）mmunoglobulin （Ig） paraprotein in chronic lymphocytic leukemia （CLL） , and to explore its clinical associated laboratory features and prognostic implication. Methods Serum protein electrophoresis and immunofixation eleetrophoresis were performed by automatic electrophoresis apparatus to identify serum Ig paraprotein. Immunonephelometry was used to measure serum Ig levels. Results Out of 101 CLL patients, serum Ig paraprotein detection was found in 20 （19.8%） cases, 13 （12.9%） patients with IgG paraprotein, 7 （6.9%） patients with IgM paraprotein and 1 （ 1.0% ） patient with IgA paraprotein. Among these 20 cases, 1 patient had both IgG and IgM paraprotein, 2 patients had both K and k light chains. The incidence of serum IgG paraproteiu was high in the group of ad- vanced Binet stage （ P = 0. 032） and high level of thymidine kinase 1 （ TK1 ） （ P = 0. 013 ）. The incidence of serum IgM paraprotein was high in the group of advanced Binet stage （ P = 0. 037 ）, high level of TK1 （ P = 0. 017） and cytogenetie abnormalities of del （ 11 q22.3 ） （P = 0. 006 ）. With a median follow-up of 30 months （range 1 - 101 months） , 66 patients received therapy after initial diagnosis. Survival analysis showed that the patients with serum Ig paraprotein had significantly shorter treatment-free survival （TFS） times than the pa- tients without serum Ig paraprotein （ P = 0. 024 ）. And the patients with serum IgM paraprotein had signifi- cantly shorter treatment-free survival （TFS） times than the patients without serum Ig paraprotein （P = 0.013）. However, serum Ig paraprotein or IgM paraprotein was not independent prognostic factor.Conclusion Serum Ig paraprotein can be detected in a subset of patients with CLL, which could be of value as a prognostic factor in CLL.