IgG型多发性骨髓瘤化疗后免疫球蛋白重/轻链表达及其与预后的关系

Correlation between the expression of immunoglobulin heavy/light chain ratio after chemotherapy and the prognosis in patients with multiple myeloma of IgG-type

目的探讨Ig G型多发性骨髓瘤(MM)化疗后免疫球蛋白重/轻链(HLC)表达对预后的影响。方法回顾性分析70例Ig G型MM化疗后完全缓解(CR)患者的临床资料,分析患者化疗后单克隆免疫球蛋白HLC检测结果、复发情况与生存情况,明确HLC对预后的影响。结果 70例化疗后CR患者的血清蛋白电泳与免疫固定电泳M蛋白检测结果均为阴性。HLC检测发现r HLC异常21例,r FLC异常18例。r HLC正常与r HLC异常患者以及r FLC正常与r FLC异常患者在年龄、性别、Durie/Salmon分期、ISS分期方面比较,差异均无统计学意义(P﹥0.05)。随访期间共7例复发,5例死亡。Cox回归分析显示r HLC与r FLC对患者无病生存时间无影响(P﹥0.05);r HLC为总生存时间的影响因素(P﹤0.05),而r FLC对总生存时间则无影响(P﹥0.05)。结论 Ig G型MM化疗后r HLC异常患者的生存时间会受到影响,HLC检测有助于预后判断。

Objective To investigate the effect of the expression of immunoglobulin（Ig G） heavy/light chain（HLC）ratio in multiple myeloma（MM） of Ig G-type after chemotherapy on the prognosis. Method Retrospective analysis was performed for the clinical data of 70 cases of MM of Ig G-type that achieved complete remission（CR） after chemotherapy. The results of monoclonal HLC ratio, recurrence and survival were analyzed, and the effect of HLC expression on prognosis was determined. Result The M protein test results of serum protein electrophoresis and immunostaining electrophoresis in the 70 cases of CR patients after chemotherapy were negative. HLC detection found r HLC abnormal in 21 cases, r FLC abnormal in 18 cases. There were no statistically significant differences in age, sex, Durie/Salmon stage, and ISS stage in patients with normal r HLC and abnormal r HLC, normal r FLC and abnormal r FLC（P〈0.05）. During followup, 7 cases had relapse and there were 5 cases of death. In Cox regression analysis, the r HLC and r FLC was of no significant effect on the disease-free survival time（P〈0.05）; while r HLC was associated with overall survival（P〈0.05）, but r FLC did not（P〈0.05）. Conclusion The survival of patients with multiple myeloma of Ig G-type may be affected by abnormal r HLC after chemotherapy, thus HLC detection is indicative in the assessment of prognosis.