血清胱抑素C、β_(2^-)微球蛋白及肌酐在多发性骨髓瘤诊断中的价值

Value of serum cystatin C, β_(2^-) microglobulin and creatinine in the diagnosis of multiple myeloma

目的探讨血清胱抑素C(cystatin C,Cys-C)、β2-微球蛋白(β2-microglobulin,β2-MG)及肌酐(creatinine,Cr)在多发性骨髓瘤(multiple myeloma,MM)中的诊断意义。方法使用日立7600全自动生化分析仪检测2010年2月-2014年1月海南农垦那大医院及南方医院住院的43例初诊MM患者和30例健康体检者血清Cys-C、β2-MG、Cr、尿酸(uric acid,UA)及尿素的水平。应用受试工作特征曲线(receiver operating characteristic curve,ROC)评价Cys-C、β2-MG和Cr在MM诊断中的价值。结果 MM患者Cys-C水平(2.06±0.82)mg/L明显高于健康对照组(0.71±0.18)mg/L(P<0.01);并且与β2-MG呈明显正相关(r=0.523,P<0.05)。Durie-Salmon分期中,Ⅲ期Cys C水平(3.14±1.38)mg/L明显高于Ⅱ期(1.35±0.16)mg/L和Ⅰ期(0.97±0.18)mg/L(P<0.01);Ⅲ期与Ⅰ期、Ⅱ期血清Cr和β2-MG水平比较差异有统计学意义(P<0.05)。不同免疫分型中,轻链型血清Cys-C水平(2.75±1.01)mg/L明显高于不分泌型(1.49±0.53)mg/L(P<0.05);Ig A型血清β2-MG水平(7.48±4.52)mg/L明显高于不分泌型(5.37±2.64)mg/L(P<0.05)。ROC分析显示,Cys C的曲线下的面积(area under curve,AUC)及其95%置信区间(0.912,95%CI:0.891~0.960)高于β2-MG(0.853,95%CI:0.821~0.894)和Cr(0.741,95%CI:0.702~0.795),差异有统计学意义(P<0.05)。结论 Cys-C可以作为诊断MM患者肾功能早期损害的指标之一,且优于β2-MG和Cr,对临床分期、肿瘤负荷及判断预后有一定的帮助。

Objective To investigate the diagnosis significance of serum cystatin C （Cys-C）,β2-microglobulin （β2-MG） and creatinine （Cr） in multiple myeloma （MM）.Methods The serum levels of Cys-C,β2-MG,Cr,uric acid （UA） and urea of 43 newly diagnosed MM patients and 30 healthy persons in Hainan Nongken Nada Hospital and Nanfang Hospital from February 2010 to January 2014 were detected using Hitachi 7600 automatic biochemical analyzer.Receiver operating characteristic curve （ROC） was used to evaluate the value of Cys-C,β2-MG and Cr in the diagnosis of MM.Results The level of Cys-C in patients with MM （2.06 ± 0.82） mg/L was significantly higher than in the control group （0.71 ± 0.18） mg/L （P ＜ 0.01）,and it was significant positive correlated with β2-MG （r=0.523,P ＜ 0.05）.During Durie-Salmon stage,the level of CysC （3.14 ± 1.38） mg/L in phase Ⅲ was significantly higher than that in phase Ⅱ （1.35 ± 0.16） mg/L and phase Ⅰ （0.97 ± 0.18） mg/L （P ＜ 0.01）.The levels of serum Cr and β2-MG in phase Ⅲ showed statistically significant difference comparing with that in phase Ⅰ and Ⅱ （P ＜ 0.05）.Cys-C level of serum light chain （2.75 ± 1.01） mg/L was significantly higher than that of no secretion （1.49 ± 0.53） mg/L in different immune classification （P ＜ 0.05）,and β2-MG level of IgA type serum （7.48 ± 4.52） mg/L was significantly higher than that of no secretion （5.37 ± 2.64） mg/L （P ＜ 0.05）.Receiver operating characteristic curve analysis showed that area under curve （AUC） and 95％ confidence interval of CysC （0.912,95％CI：0.891-0.960） were higher than that of the β2-MG （0.853,95％CI：0.821-0.894） and Cr （0.741,95％CI：0.702-0.795）,the difference was statistically significant （P ＜ 0.05）.Conclusion Cys-C can be used as one of indexes for the early diagnosis of MM patients with renal damage,which is better than β2-MG and Cr,and it also can help with clinical stage,tumor burden and prognosis.