血、尿轻链水平检测在肾脏疾病中的应用

Application of serum and urinary light chains detection in patients with renal disease

目的探讨血、尿轻链水平检测在肾脏疾病鉴别诊断中的应用价值。方法选取该院2015年10月至2016年8月收治的多发性骨髓瘤患者24例,慢性肾脏疾病患者73例。其中慢性肾功能不全48例(慢性肾功能不全组)、肾病综合征患者25例(肾病综合征组)作为观察组,并随机选择同期健康体检者30例作为对照组,分别检测其血清IgG及血、尿轻链水平,比较其差异。结果血清κ、λ水平异常在多发性骨髓瘤(83.33%、75.00%)、慢性肾脏疾病(72.60%、56.16%)患者间比较差异无统计学意义(P>0.05)。而κ/λ比值异常,在2组(95.83%、36.99%)患者间比较差异有统计学意义(P<0.05)。肾病综合征组血清IgG、κ、λ水平[(4.12±1.62)g/L、(4.14±1.20)g/L、(2.37±0.86)g/L]低于慢性肾功能不全组[(9.78±2.39)g/L、(5.98±1.16)g/L、(3.57±0.73)g/L],且两者均低于对照组[(11.41±1.74)g/L、(9.13±1.67)g/L、(4.65±0.91)g/L],差异有统计学意义(P<0.05);尿κ、λ水平,肾病综合征组[0.312 0(0.060 0,0.840 0)g/L,0.232 0(0.050 0,0.480 0)g/L]显著高于慢性肾功能不全组[0.070 0(0.030 0,0.150 0)g/L,0.050 0(0.050 0,0.110 0)g/L]和对照组[0.019 0(0.018 5,0.019 9)g/L,0.050 0(0.050 0,0.050 0)g/L],差异有统计学意义(P<0.05);慢性肾功能不全组高于对照组,差异有统计学意义(P<0.05)。结论血清轻链κ/λ比值在鉴别诊断骨髓瘤性肾病和慢性肾脏疾病具有较高准确性。血、尿轻链水平的变化在诊断不同类型的肾脏疾病、判断病情、评估肾小管损伤方面具有重要临床意义。

Objective To evaluate the application value of serum and urinary light chain levels in the differential diagnosis of renal disease.Methods Twenty-four patients with multiple myeloma（MM）and 73 patients with chronic renal diseases,including 48 cases of chronic kidney dysfunction（CKD）and 25 cases of nephropathy syndrome（NS）,served as the observation group,and contemporaneous 30 individuals undergoing the healthy physical examination were selected as the control group.The serum IgG,serum and urinary light chains levels were detected for comparing their difference.Results The levels of serumκandλhad no statistically significant difference between in the MM group（83.33%,75.00%）and chronic renal diseases group（72.60%,56.16%）,P〈0.05.The abnormality ofκ/λratio had statistical difference between the MM group and chronic renal disease group（95.83%,36.99%）,P〈0.05.The serum IgG,κandλlevels in the NS group were（4.12±1.62）g/L,（4.14±1.20）g/L and（2.37±0.86）g/L],which were significantly lower than（9.78±2.39）g/L,（5.98±1.16）g/L and（3.57±0.73）g/L in the CKD group,moreover which were lower than（11.41±1.74）g/L,（9.13±1.67）g/L and（4.65±0.91）g/L in the control group,the differences were statistically significant（P〈0.05）.The urinaryκ,λlevels in the NS group were 0.312 0（0.060 0,0.840 0）g/L and 0.232 0（0.050 0,0.480 0）g/L,which were significantly higher than 0.070 0（0.030 0,0.150 0）g/L and 0.050 0（0.050 0,0.110 0）g/L in CKD group and0.019 0（0.018 5,0.019 9）g/L and 0.050 0（0.050 0,0.050 0）g/L in the control group,the differences were statistically significant（P〈0.05）;the CKD group was higher than control group with statistical difference（P〈0.05）.Conclusion The serum light chainκ/λratio has higher accuracy in the differential diagnosis of myeloma NS and CKD.The change of the serum AND urinary light chains levels has an important clinical significant in the aspects of diagnosing different types of kidney disease,judging the disease condition and evaluating renal tubular injury.