多发性骨髓瘤患者M蛋白标记的临床意义

Clinical significance of M protein labeling in patients with multiple myeloma

目的:探讨多发性骨髓瘤(multiple myeloma, MM)患者血清蛋白电泳M蛋白标记的临床意义,观察其定量水平监测疾病进展和评估治疗药物的疗效。方法:对169例患者血清蛋白电泳的M蛋白波峰进行柱状法标记,通过免疫固定电泳(IFE)确诊其免疫分型,同时进行血清总蛋白(TP)、白蛋白(ALB)含量检测。连续追踪25例初诊诊断为MM患者的血清蛋白电泳,将M蛋白波峰标记得到M蛋白百分比,换算M蛋白浓度。换算公式:M蛋白浓度(g/L)=TP浓度(g/L)×M蛋白百分比(%),将计算结果进行对比。结果:在169例患者中,血清蛋白电泳β区见M蛋白波峰49例(29.0%)、γ区见M蛋白波峰120例(71.0%),经过IFE分型:κ型IgG型48例(28.4%),λ型IgG型43例(25.4%);κ型IgA型14例(8.3%),λ型IgA型16例(9.5%);κ型IgM 11例(6.5%),λ型IgM 3例(1.8%);κ型IgD型2例(1.2%),λ型IgD型6例(3.6%);游离κ轻链型2例(1.2%),游离λ轻链型8例(4.7%);双克隆型1例(0.6%);未见单克隆条带15例(8.9%)。随访和监测25例MM患者化疗疗效评估:化疗后较化疗前白蛋白明显升高;其中β区M蛋白4例,β球蛋白及M蛋白浓度明显降低,差异均有统计学意义(P <0.05);γ区M蛋白21例,γ球蛋白及M蛋白显著降低(P <0.05、P <0.01),其中M蛋白持续存在的MM患者,第1次评估血清TP含量和M蛋白浓度明显下降、ALB含量明显升高,第2次评估TP、ALB含量在正常参考值区间,趋于平稳,M蛋白浓度逐渐下降,可至消失。结论:血清蛋白电泳M蛋白的标记是诊断MM、巨球蛋白血症、淀粉样变等浆细胞病的依据,可作为标志物对其定量,更好的为监测疾病进展和评估治疗药物的疗效提供指导。

Objective:To investigate the clinical significance of serum protein electrophoresis M protein peak labeling in patients with multiple myeloma(MM),and to observe its quantitative level to monitor disease progression and evaluate the efficacy of therapeutic drugs.Methods:Column-like labeling was performed on the M-protein peaks that was high and narrow in the serum protein electrophoresis wave graph of 169 patients.The immunophenotype was confirmed by immunofixation electrophoresis(IFE),and serum total protein(TP)and albumin(ALB)were detected simultaneously.Serum protein electrophoresis was continuously followed-up in 25 patients with newly diagnosed multiple myeloma(MM),the M protein wave graph was labeled to obtain the percentage of M protein,and the M protein concentration was converted.Calculation formula:M protein concentration(g/L)=TP concentration(g/L)×M protein percentage(%),and the calculation results were compared.Results:Among 169 patients,49 cases(29.0%)of M protein peaks were observed in theβ-region of serum protein electrophoresis,and 120 cases(71.0%)of M protein peaks were observed inγ-region.After IFE classification:48 cases ofκ-type IgG type(28.4%),43 cases ofλtype IgG type(25.4%),14 cases ofκtype IgA type(8.3%),16 cases ofλtype IgA type(9.5%),11 cases ofκtype IgM(6.5%),3 cases ofλtype IgM(1.8%),κ-type IgD type in 2 cases(1.2%),λ-type IgD type in 6 cases(3.6%),freeκlight-chain type in 2 cases(1.2%),freeλlight-chain type in 8 cases(4.7%),double clone type 1 case(0.6%),and monoclonal bands were not found in 15 cases(8.9%).25 patients with MM chemotherapy evaluation after chemotherapy were followed up and monitored.Albumin was significantly higher than before chemotherapy.There were 4 cases of M protein peak inβ-region,the concentrations ofβ-globulin and M-protein were significantly decreased,and the difference was statistically significant(P<0.05).There were 21 cases ofγ-protein M protein peak.γ-globulin and M protein were significantly decreased(P<0.05,P<0.01),among the MM patients with persistent M protein,in the first evaluation,serum TP concentration and M protein concentration decreased significantly,and ALB concentration increased significantly.In the second evaluation,the TP and ALB concentrations tended to be stable to the normal reference interval.The M protein concentration gradually decreased to disappear.Conclusion:Serum protein electrophoresis M protein wave graph labeling is the basis for the diagnosis of MM,macroglobulinemia,amyloidosis and other plasma cell diseases,it can be used as a marker to quantify it,better to provide guidance for monitoring disease progression and evaluating the efficacy of therapeutic drugs.