轻链检测在慢性肾脏病中的应用评估

Evaluation of the clinical application of light chain detection in chronic kidney disease

目的 评估慢性肾脏病(CKD)患者在不同分期下,血总轻链(sTLC)、尿总轻链(uTLC)及血游离轻链(sFLC)水平差异及其与肾功能指标的相关性;探讨各轻链指标在CKD患者分期中的预测价值。方法 回顾性分析292例CKD患者,排除浆细胞疾病、急性肾损伤、肿瘤性疾病等。根据估算肾小球滤过率(eGFR)将CKD患者分为CKD1~5期组。检测CKD患者sTLC、uTLC、sFLC及相应生化指标,比较各组指标间差异及相关性;采用受试者应用工作曲线(ROC曲线),以CKD1~2期合并为对照组,CKD3~5期合并为病例组,分析各轻链指标在CKD分期中的预测价值。结果 CKD 1~5期多组间比较显示,sTLCκ、sTLCλ、sTLCκ/λ、sFLCκ/λ差异无统计学意义;而sFLCκ、sFLCλ、uTLCκ、uTLCλ差异有统计学意义(P<0.05),且随着CKD分期期次的增高而增高。sFLCκ、sFLCλ与肌酐(Scr)、尿素氮(BUN)、eGFR的相关系数高于uTLCκ、uTLCλ(P<0.001);sTLCκ、sTLCλ、sTLCκ/λ、sFLCκ/λ与肾功能指标相关系数低(P>0.05)。sFLCκ、sFLCλ预测CKD3~5期病例组,最佳临界点为35.4、52.8 mg/L,AUC分别为0.916(0.883~0.949)、0.915(0.881~0.949),均高于uTLCκ、uTLCλ,AUC分别为0.811 (0.754~0.869)、0.787 (0.728~0.846)。结论 随着CKD分期期次的增加,sFLC、uTLC水平逐渐增加;sFLC、uTLC能够有效预测CKD3期以上患者,对CKD患者分层管理具有重要参考价值。

Objective To evaluate the differences of serum total light chain(sTLC),urine total light chain(uTLC)and serum free light chain(sFLC)in different stages of chronic kidney disease(CKD)and their correlation with renal function indexes.To investigate the predictive value of light chain indexes in CKD staging.Methods 292 patients with CKD were analyzed retrospectively,and plasma cell diseases,acute kidney injury and tumor diseases were excluded.According to the estimated glomerular filtration rate(eGFR),CKD patients were divided into five groups from CKD 1 stage to CKD 5 stage.The levels of sTLC,uTLC,sFLC and corresponding biochemical indexes of CKD patients were detected,and the differences and correlations among the indexes of each group were compared.The receiver operating curve(ROC curve)was used to analyze the predictive value of each light chain index in CKD stage,with CKD1-2 stage combined as control group and CKD3-5 stage combined as case group.Results There was no significant difference in sTLCκ,sTLCλ,sTLCκ/λand sFLCκ/λamong CKD1-5 stage(P>0.05).There were significant differences between sFLCκ,sFLCλand uTLCκ,uTLCλamong CKD1-5 stage(P<0.05),which increased with the increase of CKD staging.The correlation between sFLCκ,sFLCλand serum creatinine(Scr),blood urea nitrogen(BUN),eGFR were better than uTLCκ,uTLCλ(P<0.001).The sTLCκ,sTLCλ,sTLCκ/λand sFLCκ/λhad no correlation with renal function indexes(P>0.05).The best critical points of sFLCκand sFLCλfor predicting CKD3-5 stage were 35.4 mg/L and 52.8 mg/L,and AUC was 0.916(0.883-0.949)and 0.915(0.881-0.949),which were higher than uTLCκand uTLCλ,AUC was 0.811(0.754-0.869)and 0.787(0.728-0.846),respectively.Conclusion With the increase of CKD staging,the levels of sFLC and uTLC gradually increase.The sFLC and uTLC can effectively predict patients with CKD3 and above,which has an important reference value in stratified management of patients with CKD.