血清游离轻链检测在肾脏相关疾病中的诊断意义和应用价值

Diagnostic significance and application value of serum free light chain detection in kidney related diseases

目的定量检测血清游离轻链(serum free light chain,sFLCκ、λ)在慢性肾脏疾病(CKD)中的水平,分析在不同情况下肾损伤时血清游离轻链的变化,探讨其在肾脏疾病中的临床意义和应用价值。方法将慢性肾脏疾病患者分为3组,62例非骨髓瘤性慢性肾脏疾病患者,22例骨髓瘤性肾病κ型患者,12例骨髓瘤性肾病λ型患者,另选取40例健康体检人群作为对照,采用散射比浊法定量检测血清游离轻链(κ、λ)的含量并计算κ/λ,并对结果进行分析。结果 62例非骨髓瘤性慢性肾脏疾病患者sFLCκ和λ,κ/λ比值均升高,与健康对照组比较有显著性差异(P<0.05);22例骨髓瘤性肾病κ型患者sFLCκ和λ,κ/λ比值与对照组比较,均有显著性差异(P<0.05);12例骨髓瘤性肾病λ型患者的sFLCκ的结果与对照组比较无显著性差异(P>0.05),sFLCλ结果与对照组比较有显著性差异(P<0.05),κ/λ比值下降,与对照组比较亦有显著性差异(P<0.05)。另外,随着CKD分期的进展,血清游离轻链κ、λ进行性地升高,尤其是在Ⅰ、Ⅱ、Ⅲ期的慢性肾脏疾病中,肾脏功能的损伤对血清游离轻链λ比对血清游离轻链κ的影响更显著。结论血清多克隆游离轻链(sFLCκ、λ)水平检测,尤其κ/λ比值可反映肾损伤程度,当用于多发性骨髓瘤疾病的辅助诊断时,可作为肾损伤情况的评估,提高临床诊断治疗的准确性。在CKD患者肾损伤程度评估中亦具有重要的临床意义。

Objective Quantitative detection of serum free light chain （serum free light chain sFLC,kappa and lamb-da）in chronic kidney disease （CKD）in the level of analysis in renal injury changes of serum free light chain in different conditions,explore the kidney disease with clinical significance and application value.Methods Kidney disease patients were divided into 3 groups,62 cases of non tumor bone marrow of patients with chronic kidney disease,22 cases of mye-loma nephropathy in patients with typeκ,12 cases of myeloma nephropathy patients with typeλ,the other 40 healthy cases were selected as control group,using nephelometry quantitative detection of serum free light chain （kappa,lamb-da）content and calculated the kappa/lambda,and the results were analyzed.Results 62 cases of non myeloma kidney disease in patients with chronic sFLC kappa and lambda,kappa / lambda ratio were increased,there were significant differences between the control group and health （P 〈 0.05）;22 cases of sFLC myeloma nephropathy patients with type k kappa and lambda,kappa/lambda ratio compared with the control group,there were significant differences（P 〈0.05）;the results of 12 cases of myeloma nephropathy in patients with typeλ sFLC kappa compared with the control group had no significant difference （P 〉0.05,sFLC）.Results of lambda there was significant difference compared with the control group （P 〈0.05）,kappa/ lambda ratio decreased,compared with the control group,there was significant difference （P 〈0.05）.In addition,with the CKD stage of development,serum free light chain kappa and lambda was in-creased,especially in patients with chronic kidney disease Ⅰ,Ⅱ and Ⅲ.In the effect of kidney on serum free light chain lambda is more significant than serum free light chain kappa.Conclusion Polyclonal serum free light chain （sFLC kap-pa,lambda）level detection,especially the kappa/lambda ratio can reflect the severity of kidney damage,when used in the diagnosis of multiple myeloma disease,can be used as the assessment of kidney injury,improve the accuracy of clini-cal diagnosis and treatment.In the evaluation of the degree of renal injury in CKD patients also has important clinicalsignificance.