意义未明单克隆免疫球蛋白血症早期发现的实验室诊断指标探讨

Study on laboratory diagnostic indexes for early detection of monoclonal gammopathy of undetermined significance

目的 探讨意义未明单克隆免疫球蛋白血症(monoclonal gammopathy of undetermined significance,MGUS)实验室诊断指标特征,以便尽早诊断该疾病。方法 回顾性分析2017年1月-2020年7月本院MGUS患者32例,分析血常规、M蛋白类型等检查;另选32例健康体检者作对照组。结果 血红蛋白偏低21例(65. 6%);尿蛋白水平升高15例(46. 88%);总蛋白偏高2例(6. 25%);球蛋白偏高8例;白球蛋白比值偏低29例(90. 6%);肌酐水平升高16例(50%);血钙水平偏高0例;血沉升高30例(93. 8%);Ig G型20例占62. 5%,Ig A型11例占34. 38%,Ig M型1例占3. 13%;M蛋白类型相对应的免疫球蛋白量、轻链与正常组相比差异有统计学意义(P <0. 05)。结论 MGUS患者可以出现部分CRAB症状(高钙血症、肾损害、贫血、骨损害)。当患者出现球蛋白偏高、免疫球蛋白≥15 g/L、血沉重度升高时要进行血清电泳和免疫固定电泳检测,及时发现M蛋白。

Objective To explore the laboratory diagnostic characteristics of monoclonal gammopathy of undetermined significance(MGUS)for early diagnosis of this disease.Methods Thirty two cases of MGUS patients hospitalized in our hospital from January 2017 to July 2020 were retrospectively analyzed.Blood routine test and M protein type test were performed.Another 32 healthy subjects were selected as control group.Results Hemoglobin was low in 21 cases(65.6%);urinary protein level increased in 15 cases(46.88%);total protein was high in 2 cases(6.25%);globulin was high in 8 cases;white globulin ratio was low in 29 cases(90.6%);creatinine increased in 16 cases(50%);blood calcium level was high in 0 case;erythrocyte sedimentation rate(ESR)increased in 30 cases(93.8%);20 cases of IgG accounted for 62.5%,11 cases of IgA type accounted for 34.38%,and 1 case of IgM type accounted for 3.13%;There was statistical significance on the differences in the amount of immunoglobulin and light chain of M protein type between the two groups(P<0.05).Conclusion Some CRAB symptoms(hypercalcemia,renal damage,anemia,bone damage)can occur in MGUS patients.When patients were with high globulin,immunoglobulin≥15 g/L and severe increase of ESR,serum electrophoresis and immunofixation electrophoresis should be carried out to detect M protein in time.