常规临床检验项目对IgD型和轻链型多发性骨髓瘤分型鉴别的价值

Value of Routine Clinical Tests in the Differential Diagnosis of IgD and Light Chain Multiple Myeloma

目的探讨常规临床检验项目对IgD型和轻链型多发性骨髓瘤(MM)分型鉴别的价值。方法回顾性分析45例IgD型MM患者(男30例,女15例,中位年龄61.3岁)和64例轻链型MM患者(男41例,女23例,中位年龄62.4岁)的病历资料,对2组患者的常规检验指标进行比较,并采用logistic回归建立预测模型。结果免疫固定电泳轻链κ和λ分型结果显示,IgD型MM组κ型和λ型分别占8.9%和91.1%,以λ型为主,IgD型MM组和轻链型MM组轻链构成存在统计学差异(P<0.01)。与轻链型MM组比较,IgD型MM组白蛋白(P<0.01)、血清蛋白电泳白蛋白区带(SPE-ALB)(P<0.01)、血清蛋白电泳α2区带(SPE-α2)(P<0.01)、IgG(P<0.05)明显降低,血清蛋白电泳γ区带(SPE-γ)(P<0.01)明显升高。基于轻链类型、SPE-ALB及SPE-γ这3个指标建立logistic回归方程,对轻链阳性患者进行IgD型MM分型预测,ROC曲线下面积为0.863(0.788~0.937),IgD型鉴别的敏感度为77.8%,特异度为79.7%,准确度为78.9%。结论基于轻链类型、SPE-ALB和SPE-γ建立的预测模型对轻链阳性患者的IgD分型鉴别有重要价值。

Objective To explore the value of routine clinical tests in the differential diagnosis of IgD and light chain multiple myeloma(MM).Methods We retrospectively analyzed the medical records of 45 patients with IgD type MM(including 30 men and 15 women with a median age of 61.3 years)and 64 patients with light chain type MM(including 41 men and 23 women with a median age of 62.4 years).The routine tests of these two groups were compared,and logistic regression was used to establish the predictive model.Results The results of immunofixation electrophoresis showed that the IgD type MM group was predominantlyλtype(the percentage ofκwas 8.9%and ofλwas 91.1%),and there were significant differences in the composition of the light chain between IgD type and light chain type MM groups(P<0.01).Compared with those in the light chain type MM group,albumin(P<0.01),SPE-ALB(P<0.01),SPE-α2(P<0.01),and IgG(P<0.05)in IgD type MM group were significantly lower,while SPE-γ(P<0.01)was significantly higher.Logistic regression equation was established based on light chain type,SPE-ALB,and SPE-γ.The area under the receiver operating characteristic curve was 0.863(0.788-0.937)for predicting IgD type in light chain-positive patients.The sensitivity,specificity,and accuracy of the model were 77.8%,79.7%,and 78.9%,respectively.Conclusion The predictive model based on light chain type,SPE-ALB,and SPE-γhas great clinical value in the identification of IgD in light chain-positive MM patients.