单克隆免疫球蛋白血症患者M蛋白浓度检测的临床意义

Clinical significance of M-protein concentration detection in patients with monoclonal immunoglobulinemia

目的:探讨单克隆免疫球蛋白血症患者M蛋白浓度检测的临床意义.方法:检测M蛋白浓度,收集患者临床和病理资料,分析M蛋白浓度与疾病类型及预后特征的关系.结果:142例M蛋白阳性患者男女比1.49:1,中位年龄为60.0岁.其中IgG型88例(62.0%),IgA型35例(24.7%),IgM型9例(6.3%),单纯轻链型7例(4.9%),单纯重链型1例(0.7%),IgA与IgG双M蛋白型2例(1.4%).轻链分型中,κ型占36.2%,λ型占63.8%.疾病谱包括具有肾脏意义的单克隆免疫球蛋白血症(MGRS)78例(54.9%),意义未明的单克隆免疫球蛋白血症(MGUS)39例(27.5%),血液系统恶性肿瘤合并单克隆免疫球蛋白血症(MG)25例(17.6%).血液系统恶性肿瘤合并MG患者中位M蛋白浓度显著高于MGRS(4.25 g/L vs 2.40 g/L,P=0.019)及MGUS患者(4.25 g/L vs 2.56 g/L,P=0.043).所有患者M蛋白浓度与血清钙(Ca)呈正相关,与血清总胆固醇(TC)、24h尿蛋白定量呈负相关(P<0.05).血液系统恶性肿瘤合并MG患者M蛋白浓度与血清肌酐、尿素氮(BUN)、Ca呈正相关,与血红蛋白、血小板、TC呈负相关;MGRS患者M蛋白浓度与血清TC呈负相关(P<0.05).结论:本研究中M蛋白阳性患者以中老年男性为主,血液系统恶性肿瘤患者M蛋白浓度最高.M蛋白浓度与部分实验室指标有一定的相关性.

Objective:To discuss the clinical significance of the M-protein concentration detection in patients with monoclonal immunoglobulinemia.Methodology:Data from monoclonal immunoglobulin cases screened in our laboratory for 8 months were used to assemble a cohort of 142 cases selected according to immunofixation interpretation.The serum protein electrophoresis and image analysis software were used to detecte the M-protein concentration.The clinical,laboratory and pathological characteristics of 142 patients with M-protein were analyzed comprehensively.Results:A total of 142 patients were included in the study.There were 85 males and 57 females with male predominance,with a median age of 60.0 years.The M-proteins in that cohort were 62.0%IgG,24.7%IgA,6.3%IgM,4.9%free light chain,0.7%heavy chain,1.4%IgG and IgA;κ accounted for 36.2%andλaccounted for 63.8%among the light chain types.Monoclonal gammopathy of renal significance(MGRS)accounted for the highest proportion(53.9%),monoclonal gammopathies of undetermined signifIcance(MGUS,27.5%),hematopoietic malignancies associated with monoclonal gammopathy(MG)(17.6%).Patients with hematopoietic malignancies associated with MG had a high medium M-protein concentration than those with MGRS(4.25g/L vs.2.40g/L,P=0.019)and MGUS(4.25 g/L vs.2.56 g/L,P=0.043).The M-protein concentration was positively correlated with serum calcium,and negatively correlated with total serum cholesterol,24 hour urinary protein(P<0.05).In patients with hematopoietic malignancies associated with MG,M-protein concentration was positively correlated with serum creatinine,urea nitrogen and calcium,and negatively correlated with hemoglobin,platelets and total serum cholesterol;in patients with MGRS,it was negatively correlated with total serum cholesterol.Conclusion:In this research,patients with monoclonal immunoglobulinemia were mainly elderly men.Patients with hematopoietic malignancies associated with MG had the highest M-protein concentration.The M-protein concentration correlated with some laboratory results.