运用血清法综合诊断M蛋白的重要性及相关思考

The significance of the comprehensive diagnosis of M protein by applying serum assay and relevant thinking

目的通过对M蛋白阳性患者血清免疫球蛋白IgG、IgA、IgM及κ、λ轻链定量测定、血清蛋白电泳(SPE)和免疫固定电泳(IFE)的结果分析,探讨其对诊断M蛋白的指导意义,防止误诊和漏诊,不断提高检验质量和临床诊断价值。方法对2013年1244例M蛋白阳性患者的血清IgG、IgA、IgM及κ、λ轻链定量测定、SPE、IFE检测结果进行统计,回顾性分析其相互关联及在诊断M蛋白中的重要价值。结果血清蛋白电泳中出现M蛋白单峰的有944例(76%);出现M蛋白双峰的有27例(2%);未出现M蛋白峰的有273例(22%)。在未出现M蛋白峰的273例患者中,IgA型102例,IgG型44例,IgM型3例,κ游离轻链型41例,λ游离轻链型55例,IgD型28例。M蛋白类型:IgG型644例(51.8%);IgA型288例(23.2%);IgM型85例(6.8%);轻链型131例(10.5%);IgD型69例(5.5%);双克隆型27例(2.2%)。κ游离轻链型的κ在正常范围(2.69±1.81),相比正常对照组升高无显著性差异(P>0.05),但κ/λ相比升高有极显著性差异(P<0.001),IgG、IgA、IgM、λ降低有极显著性差异(P<0.001);IgGκ、IgGλ、IgAκ、IgAλ、IgMκ、IgMλ、λ游离轻链型的数据具有统计学意义。结论血清IgG、IgA、IgM及κ、λ轻链定量测定、SPE和IFE在诊断M蛋白方面不可缺少,不能相互替代,但能相互补充,只有综合分析其结果才能给临床提供更加可靠的依据。

Objective By？analyzing the results of serum immunoglobulin including IgG,IgA,IgM,κ and λ,serum protein electrophoresis（SPE）and immunofixation electrophoresis（IFE）of M protein positive patients,Investigate the guiding significance of the diagnosis of M protein,avoid misdiagnosis and missed diagnosis,Constantly improve the quality of test and clinical diagnostic value.Methods Make a statistics of the results of serum immunoglobulin including IgG,IgA,IgM,κandλ,SPE and IFE of M protein positive patients in 2013,and retrospectively analyze the correlation and significant value of the diagnosis of M protein.Results M protein single bands seen by using SPE include 944 cases（76%）,M protein double bands include 27 cases（2%）,M protein bands being not seen include 273 cases（22%）. In 273 cases of patients of M protein bands being not seen,there were 102 cases of IgA type,44 cases of IgG type,3 cases of IgM type,41 cases ofκfree light chain type,55 cases ofλfree light chain type,28 cases of IgD type.The type of M protein：there were 644 cases of IgG type（51.8%）,288 cases of IgA type（23.2%）,85 cases of IgM type（6.8%）, 131 cases of light chain type（10.5%）,69 cases of IgD type（5.5%）,27 cases of double-clonal type（2.2%）.Compared with normal control group,κofκfree light chain type was within the normal range（2.69±1.81）and there was no significant differences（P 〉0.05）,butκ/λ was higher and there was extremely significant difference（P 〈0.001）,IgG,IgA, IgM,λwere lower and there was extremely significant difference（P 〈 0.001）.IgGκ,IgGλ,IgAκ,IgAλ,IgMκ,IgMλ,λfree light chain type were with statistical significance.Conclusion The test of serum immunoglobulin and light chain, SPE and IFE in the diagnosis of M protein are indispensiable,cannot replace each other,but can complement each other,only comprehensive analysis of the results can provide more reliable basis for clinical.