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目的探讨4种电泳筛查多发性骨髓瘤(multiple myeloma,MM)及其分型的价值。方法收集我中心164例MM患者作为病例组(MM患者组),同时收集45例健康体检者作为对照组(非MM组),所有研究对象均采集血液和尿液。用血清蛋白电泳(serum protein electrophoresis,SPE)和高分辨尿蛋白电泳(high resolution urinary protein electrophoresis,HR)分别对所有研究对象的血液和尿液样本进行M蛋白筛查,然后用血清免疫固定电泳(immunofixation electrophoresis,IFE)和尿本周氏蛋白电泳(Bence-Jones protein electrophoresis,B-J)对所有研究对象进行分型;并用罗氏生化仪检测所有研究对象的血清总蛋白(total protein,TP)、白蛋白(albumin,ALB)、球蛋白(globulin,GLOB)、免疫球蛋白(immunoglobulin,Ig)及轻链定量,并计算轻链比值。结果 SPE和HR对164例MM患者M蛋白的检出率分别为92.68%和59.76%,IFE和B-J的检出率分别为98.17%和59.76%。45例非MM组经4种电泳均未检出M蛋白。与非MM组相比较,MM患者组的TP、GLOB、轻链κ、λ含量显著升高,差异有统计学意义(t=34.968,38.231;F=72.811,58.611;P<0.05)。轻链型患者HR、B-J的阳性率明显高于IgA型患者、IgG和IgM型患者,差异具有统计学差异(χ~2=6.870,13.236,19.725;P<0.05)。结论 IFE是MM诊断最敏感的检测方法,使用多种电泳方法结合免疫球蛋白及轻链定量同时检测,可以明确分型,有效避免漏诊、误诊,为临床全面评估病情提供依据。
Objective To investigate the value of four electrophoresis screening multiple myeloma (MM) and its typing. Methods A total of 164 MM patients in our center were collected as case group (MM group) and 45 healthy subjects were collected as control group (non-MM group). Blood and urine were collected from all subjects. The serum and urine samples from all subjects were screened for M protein by serum protein electrophoresis (SPE) and high resolution urinary protein electrophoresis (HR), respectively, and then detected by serum immunostaining Immunofixation electrophoresis (IFE) and Benj-Jones protein electrophoresis (BJ) were used to classify all the subjects. The total protein (TP), albumin Albumin (ALB), globulin (GLOB), immunoglobulin (Ig) and light chain were quantified and the light chain ratio was calculated. Results The detection rates of M and M protein in 164 MM patients by SPE and HR were 92.68% and 59.76%, respectively. The detection rates of IFE and B-J were 98.17% and 59.76% respectively. 45 cases of non-MM group by four kinds of electrophoresis were not detected M protein. Compared with non-MM group, the levels of TP, GLOB, light chain κ and λ in MM patients were significantly increased, the difference was statistically significant (t = 34.968,38.231; F = 72.811,58.611; P <0.05). The positive rates of HR and B-J in patients with mild hepatitis were significantly higher than those in patients with IgA, IgG and IgM (χ ~ 2 = 6.870,13.236,19.725; P <0.05). Conclusion IFE is the most sensitive detection method for MM diagnosis. With multiple electrophoretic methods combined with quantitative detection of immunoglobulin and light chain, IFE can be clearly typed, effectively avoiding misdiagnosis and misdiagnosis, providing a basis for comprehensive clinical evaluation.