【摘要】 目的探讨血清游离轻链(sFLCs)及其κ型与λ型比值(κ/λ值)在高球蛋白疾病良恶性鉴别中的临床价值。方法收集2012年1—8月北京大学人民医院血液科收治的多发性骨髓瘤(MM)65例,选取同期就诊于风湿免疫内科的高球蛋白血症患者31例。采用免疫比浊法测定sFLCs。比较两组免疫球蛋白、sFLCs、κ/λ值水平。结果 MM患者sFLCs质量浓度显著高于自身免疫疾病组(P<0.05),良恶性疾病κ/λ值差异有统计学意义(P<0.05)。κ型MM患者κ/λ值鉴别良恶性疾病的ROC曲线下面积(AUC)为0.92,最佳临界点为2.18时,其所对应敏感度为71%,特异度为100%。λ型MM患者κ/λ值鉴别良恶性疾病的AUC 0.82,最佳临界点为0.48时,其所对应的敏感度为79%,特异度为87%。κ型MM患者高κ/λ组较低κ/λ组生存时间短(P<0.05),λ型MM患者高κ/λ组较低κ/λ组生存时间长(P<0.05)。结论 sFLC的κ/λ值对于鉴别高球蛋白疾病良恶性有较高的敏感度和特异度,且对于κ型MM低肿瘤负荷患者诊断效能更高。κ/λ值与MM预后密切相关。更多还原

【Abstract】 Objective To explore the clinical significance of serum free light chain(sFLC) levels and their κ/λratios in the differential diagnosis of hypergammaglobulinemia.Methods Sixty-five patients with multiple myeloma(MM) from the department of hematology and thirty-one patients with autoimmune diseases from the department of rheumatology were eligible for this research and the sFLCs were detected by immuno-turbidimetry.The levels of sFLCs and κ/λ ratios were quantitatively analyzed and the ROC curve was drawn according to the κ/λ ratios to find the best diagnostic differential point.The correction between κ/λ ratios and other B-cell active markers were also analyzed.Results The sFLCs levels were significantly higher in MM patients than in controls,and the κ/λ ratios in MM patients were statistically different from those in controls(P<0.05).The sensitivity was 71% and the specificity was 100% when the optimal cut-off point was set at 2.18 in sFLC-κ MM patients and the area under cure was 0.92;the sensitivity was 79% and the specificity was 87% when the optimal cut-off point was set at 0.48 in sFLC-λ MM patients and the area under cure was 0.82.The κ/λ ratios were strongly correlated with survival(P<0.05).Conclusion The κ/λ ratios are of high specificity and sensitivity in the differential diagnosis of hypergammaglobulinemia,especially for κ-type MM patients with low tumor burden.The κ/λ ratios are closely correlated with prognosis.更多还原