IgA钩状效应结合果糖胺联合诊断IgA型多发性骨髓瘤的临床价值

The clinical value of serum fructosamine measurement in the identification of IgA hook effect

为研究血清果糖胺(fructosamine,FMN)水平在IgA钩状效应识别中的应用价值,选取沧州市3家医院2011年1月至2016年10月收治的IgA型多发性骨髓瘤(multiple myeloma,MM)患者(IgA型组)64例、IgG型MM患者(IgG型组)75例、IgM型MM患者(IgM型组)8例和IgA增高的慢性肝病(chronic liver disease,CLD)患者(CLD组)60例作为研究对象,检测血清FMN水平和免疫球蛋白水平,分析FMN与IgA的相关性;选取高浓度IgA血清样本1份,通过倍比稀释配制成不同浓度梯度的样本17份,绘制剂量-反应曲线,找出IgA的平衡点浓度。所有入选病例均排除糖尿病。结果显示,IgA型组FMN水平明显高于其他各组,差异有统计学意义(P<0.05),IgG型组、IgM型组和CLD组之间比较差异无统计学意义(P>0.05);相关性分析表明,FMN与IgA型组IgA呈明显正相关(r=0.822,P<0.05),与CLD组IgA无明显相关性(r=0.143,P>0.05);剂量-反应曲线平衡点浓度约为7.0g/L,达到该点后,反应的吸光度随着浓度的增加而降低。以上结果说明,IgA存在钩状效应,而高浓度IgA的钩状效应可通过FMN有效识别,低浓度IgA则不行。

To evaluate the clinical value of serum fructosamine（FMN） level in the identification of IgA hook effect,64 cases of IgA type multiple myeloma（MM） patients（IgA type group）, 75 cases of IgG type MM patients（IgG type group）, 8 cases of IgM type MM patlents（IgM type group）and 60 cases of chronic liver disease（CLD）patients（CLD group） with high IgA levels were selected in three, hospitals of Cangzhou from January 2011 to October 2016,and the levels of serum FMN and immunoglobulins were analyzed, then the relationship between FMN and IgA was analyzed. One serum sample with high concentration of IgA was selected,17 samples with different concentrations of IgA were prepared by dilution ratio, and the dose-response curve was drawn. Diabetes were excluded from all the groups. Our results showed that the levels of FMN were significantly higher in IgA type group than those in the other groups（P 〈0.05）, and the differences were not statistically significant among IgG type group, IgM type group and CLD group（P 〉0. 05）. The results of linear correlation analysis indicated that serum FMN was positively eorrelated with IgA of IgA type group（r=0. 822 ,P 〈0.05）, and not correlated with IgA of CLD group（r=0. 143 ,P〉 0.05）. The dose-response curve inflection point appeared at 7.0 g/L approximately. After the point was reached, the absorbance of the reaction decreased with the increase of the eoncentration. Thus, this study shows that the measurement of IgA has hook effect, and the hook effect of high concentration of IgA can be identified by FMN, but that of low concentration of IgA can not be identified.