果糖胺联合白蛋白/球蛋白比值在IgA型多发性骨髓瘤诊断中的价值

Value of fructosamine and albumin/globulin ratio in diagnosis of IgA type multiple myeloma

目的探讨果糖胺(FMN)联合白蛋白(ALB)/球蛋白(GLB)(A/G)比值在免疫球蛋白A(IgA)型多发性骨髓瘤(MM)诊断中的价值。方法选取IgA型MM患者(IgA型组)64例、免疫球蛋白G(Ig G)型MM患者(Ig G型组)70例、免疫球蛋白M(Ig M)型MM患者(Ig M型组)7例、自身免疫病患者(AID组)60例和健康体检者(对照组)50例。采用硝基四氮唑蓝比色法测定FMN,双缩脲法测定总蛋白(TP),溴甲酚绿法测定ALB,并计算A/G比值。所有纳入患者排除糖尿病。分析FMN与各检验指标的关系。采用受试者工作特征(ROC)曲线分析相关指标对IgA型MM的诊断价值。结果 IgA型组FMN与其他组比较,差异有统计学意义(P<0.05);直线相关分析表明,血清FMN与IgA型组的TP、GLB呈正相关(r=0.831和0.869,均P=0.000),与ALB、A/G呈负相关(r=-0.733和-0.716,均P=0.000);FMN、A/G单独及联合检测诊断IgA型MM的ROC曲线下面积分别为0.976、0.207和0.980。单独检测时FMN诊断的敏感性(98.4%)和特异性(74.9%)高于A/G(95.3%和44.4%),联合检测时可以提高诊断的特异性(90.9%),而敏感性(95.3%)未降低。结论 FMN可以作为诊断IgA型MM的参考指标之一。FMN联合A/G检测能提高诊断的特异性,同时仍具有较高敏感性,适合做IgA型MM的筛查。

Objective To explore the value of fructosamine （FMN） and albumin （ALB）/globulin （GLB） （A/G） ratio in the diagnosis of immunoglobulin A （IgA） type multiple myeloma （MM）. Methods Sixty-four patients with IgA type MM （IgA type group）, 70 patients with immunoglobulin G type MM （IgG type group）, 7 patients with immunoglobulin M type MM （IgM type group）, 60 patients with autoimmune disease （AID group） and 50 people with healthy examination （control group） were selected. FMN was analyzed by nitro-blue-tetrazolium colorimetric method. Total protein （TP） was analyzed by biuret method. ALB was analyzed by bromocresol green method and then A/G was calculated. All selected cases were excluded from diabetes. The correlations between FMN value and laboratory indexes were analyzed. The receiver operating characteristic （ROC） curve was used to analyze the value of the indexes in the diagnosis of IgA type MM. Results FMN level of the IgA type group was obviously higher than those of other groups （P 〈0.05）. The results of linear correlation analysis indicated that serum FMN was positively correlated with TP and GLB in the IgA type group （ r=0.831 and 0.869, P=0.000）, and negatively correlated with ALB and A/G （r =-0.733 and -0.716, P=0.000）.Areas under the ROC curves of FMN, A/G single detection and joint detection for the diagnosis of IgA type MM were 0.976, 0.207 and 0.980, respectively. The sensitivity and specificity （98.4% and 74.9%） of FMN single detection were higher than those of A/G single detection （95.3% and 44.4%）. Using FMN and A/G joint detection, the specificity （90.9%） increased in the clinical diagnosis of IgA type MM without decreasing the sensitivity （95.3%）. Conclusions FMN can be one of the reference indexes for diagnosis of IgA type MM. Joint detection of FMN and A/G can improve specificity while still has high sensitivity. They are appropriate for screening of IgA type MM.