多发性骨髓瘤血清学诊断及免疫特征分析

Analysis of Serological Diagnosis and Immunological Characteristics with Multiple Myeloma

目的探讨多发性骨髓瘤（multiple myeloma,MM）患者血清M蛋白类型分布、免疫特征与临床诊断相关性,评价血清学诊断在临床应用中的价值。方法采用免疫固定电泳（immunofixation electrophoresis,IFE）、血清蛋白电泳（serum protein electrophoresis,SPE）、速率散射比浊定量方法,对9120例MM患者血清进行检测并计算κ/λ比值。结果各类型MM患者所占比例不同,IgG型占49.07%、IgA型占21.33%、IgM型占7.15%、IgD型占4.05%、轻链型多发性骨髓瘤（light chain multiple myeloma,LCMM）占18.41%。各类型MM所属的Ig含量成单一明显增高,而非所属的Ig含量明显降低。在轻链中κ型含量增高有5085例占55.76%,λ型有4035例占44.24%,IgG、IgA、IgM型以κ型轻链为主,IgD型、LCMM型以λ型为主,所属κ型轻链κ/λ比值明显升高,所属λ型κ/λ比值明显降低。在M蛋白区带分布中IgG、IgM和LCMM-κ型M蛋白位于快r区~慢r区之间,分别占MM的95.24%、100%和96.02%;IgA、IgD和LCMM-λ型M蛋白位于α2~快r区之间,占MM的90.64%、100%和88.29%。结论血清学诊断具有一定特征性,M蛋白定量、定性联合检测可提高MM诊断的准确性,具有临床应用价值。

Objective To analyze the correlation of serum M protein type distribution,immune characteristics and clinical diagnosis of multiple myeloma（MM）patients.Methods The serum levels in 9120 MM patients were tested by immunofixation electrophoresis（IFE）,serum protein electrophoresis（SPE）and rate nephelometry,meanwhile,κ/λratio was calculated.Results The proportion of various type in MM patients were different as follows：IgG49.07%,IgA21.33%,IgM7.15%,IgD4.05% and light chain multiple myeloma（LCMM）18.41%.Ig content in every type of MM was single and increased or otherwise different.A total of 5085 cases inκcontents of light chain were incresed about55.76% and 4035 casesλcontents were about 44.24%.IgG,IgA,IgM was given priority to withκtype light chain,IgD,LCMM was given priority to withλtype.The ratio ofκ/λwas increased inκtype light chain and decreased inλtype light chain.IgG,IgM and LCMM-κtype M protein in M protein zone was located between fast r and slow r area,about95.24%,100% and 96.02% of MM,respectively.IgA,IgD and LCMM-λtype M protein was located betweenα2 and fast r area,about 90.64%,100% and 88.29% of MM,respectively.Conclusion Serological diagnosis has a certain characteristic.Combining the quantitative and qualitative detection of M protein can improve accuracy of MM diagnosis that have value in clinical application.