血清果糖胺检测在IgA型多发性骨髓瘤诊断中的价值

Value of serum fructosamine detection in diagnosis of IgA type multiple myeloma

目的探讨血清果糖胺(FMN)检测在IgA型多发性骨髓瘤(MM)诊断中的价值。方法选取77例IgA型MM患者(IgA型组)、82例IgG型MM患者(IgG型组)、7例IgM型MM患者(IgM型组)及50例血清IgA>5.0g/L的自身免疫病患者(AID组),均排除糖尿病患者。采用硝基四氮唑蓝比色法检测血清FMN水平,采用Pearson直线相关分析其与总蛋白(TP)、白蛋白(ALB)、球蛋白(GLB)、IgA的关系。按Durie和Salmon分期标准将77例IgA型MM患者分为Ⅰ期28例、Ⅱ期24例、Ⅲ期25例,比较不同组别及不同分期FMN水平的差异。采用受试者工作特征(ROC)曲线评价FMN对IgA型MM的诊断效能。结果 IgA型组FMN水平与其他三组比较,P均<0.05;IgA型MM患者血清FMN水平Ⅰ期<Ⅱ期<Ⅲ期,且各期与AID组比较,P均<0.05。IgA型组血清FMN水平与TP、GLB、IgA呈正相关性(r分别为0.805、0.823、0.836,P均<0.05),与ALB呈负相关(r=0.732,P<0.05)。AID组血清FMN水平与IgA无相关性(r=0.162,P>0.05)。血清FMN诊断IgA型MM的ROC曲线下面积为0.981,以3.1 mmol/L为诊断界值的诊断准确度最高。结论排除糖尿病及样本因素的影响,血清FMN对IgA型MM诊断准确度高。

Objective To investigate the value of serum fructosamine （FMN） detection in the early diagnosis of IgA type multiple myeloma （MM）. Methods Seventy-seven IgA type MM patients （IgA type group）, 82 IgG type MM patients （IgG type group）, 7 IgM type MM patients （IgM type group）, and 50 autoimmune disease patients （AID group） with serum IgA〉5.0 g/L were selected. The diabetic patients were excluded from the selected cases. The levels of serum FMN were analyzed by nitro-blue-tetrazolium colorimetric method. Pearson′s linear correlation analysis was used to analyze the relationship of serum FMN with the total protein （TP）, albumin （ALB）, globulin （GLB）, and IgA. According to the staging criterion of Durie and Salmon （DS）, 77 IgA type MM patients were classified into 28 cases of stageⅠ, 24 cases of stage Ⅱ, and 25 cases of stage Ⅲ. The difference of FMN was compared in different groups and different stagings. The diagnostic value of FMN in IgA type MM was evaluated by the receiver operating characteristic （ROC） curve. Results The level of FMN in IgA type group was higher than those in the other three groups （all P〈0.05）. The levels of serum FMN of stage Ⅲ in IgA type MM patients were higher than those of stage Ⅱ, those of stage Ⅱwere higher than those of stageⅠ, and those of all stages were higher than those of AID group （all P〈0.05）. The levels of serum FMN in IgA type group were positively correlated with TP, GLB and IgA （r=0.805, 0.823, and 0.836, respectively; all P〈0.05）, and were negatively correlated with Alb （r=-0.732, P〈0.05）. The levels of serum FMN in AID group were not correlated with IgA （r=0.162, P〉0.05）. According to ROC analysis, the area under the curve of serum FMN for detection of IgA type MM was 0.981, and the accuracy was the highest for the cut-off value of 3.1 mmol/L. Conclusion In addition to the influence of diabetes and sample factors, the accuracy of serum FMN is high in early diagnosis of IgA type MM.