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目的:探讨血清、尿液轻链含量及κ/λ比值差异在鉴别诊断多发性骨髓瘤(MM)中的临床应用价值。方法:回顾性分析9 120例各类型MM患者血清轻链含量及κ/λ比值数据,并将其中合并肾损伤和无肾损伤MM患者的血、尿轻链及κ/λ比值分别与38例肾病者及100例正常对照者进行比较分析。结果:各类型MM患者所属血清κ型轻链及κ/λ比值显著升高,所属λ型及κ/λ比值显著降低,合并肾损伤检出率约占MM的49.57%,肾损伤MM者血清轻链含量及κ/λ比值均低于无肾损伤MM者(P<0.05),但尿液中所属轻链含量显著升高(P<0.01)。肾损伤MM患者中同一轻链型多发性骨髓瘤(LCMM)血清与尿液轻链含量及κ/λ比值比较差异有统计学意义(P<0.01),而非LCMM血清与尿液轻链含量及κ/λ比值比较差异无统计学意义(P>0.05),与肾病者及正常对照者比较差异有统计学意义(P<0.01)。结论:血清、尿液轻链含量尤其κ/λ比值差异,对MM的诊断、分型、早期肾损伤及肾病的鉴别诊断有重要的临床应用价值。
Objective: To investigate the clinical value of the light chain content of serum and urine and the difference of κ / λ ratio in the differential diagnosis of multiple myeloma (MM). Methods: The data of serum light chain and kappa / λ ratio in 9 120 MM patients were retrospectively analyzed. The blood, urine light chain and kappa / λ ratio in patients with and without renal injury were compared with those in 38 patients Nephropathy and 100 normal controls were compared. Results: The serum level of kappa light chain and the ratio of kappa to lambda were significantly increased in all types of MM patients, and the ratio of λ and κ / λ significantly decreased. The detection rate of combined renal injury accounted for 49.57% of MM, The light chain content and kappa / λ ratio were lower than those without renal injury (P <0.05), but the content of light chain in urine was significantly increased (P <0.01). The levels of light chain and kappa / λ in the serum and urine of the same MMLC patients with MMLC were significantly different (P <0.01), but not those of the LCMM serum and urine (P <0.05). There was significant difference between the two groups (P <0.01). Conclusion: The light chain contents of serum and urine, especially the ratio of κ / λ, have important clinical value in the diagnosis, classification, early renal injury and differential diagnosis of MM.