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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。
Objective To investigate the clinical value of serum free light chains (sFLCs) and their κ and λ ratio (κ / λ values) in the differential diagnosis of benign and malignant glomerular diseases. Methods Sixty-five patients with multiple myeloma (MM) admitted to Department of Hematology, Peking University People’s Hospital from January to August in 2012 were enrolled. Totally 31 patients with hypergammaglobulinemia were enrolled in the department of rheumatic immunity during the same period. Immunofluorescence assay was used to determine sFLCs. The immunoglobulin, sFLCs, κ / λ levels were compared between the two groups. Results The concentration of sFLCs in MM patients was significantly higher than that in autoimmune diseases group (P <0.05). The difference of κ / λ between benign and malignant diseases was statistically significant (P <0.05). The area under curve (AUC) of κ / λ differential benign and malignant diseases with κ type MM was 0.92. The optimal cutoff point was 2.18, which corresponded to a sensitivity of 71% and a specificity of 100%. The κ / λ of λ-type MM patients showed AUC 0.82 for benign and malignant diseases. The best cut-off point was 0.48, corresponding to a sensitivity of 79% and a specificity of 87%. The survival time of high κ / λ group was shorter than that of high κ / λ group (P <0.05), while it was longer in high κ / λ group than that of low κ / λ group (P <0.05). Conclusions The kappa / lambda value of sFLC is highly sensitive and specific for identifying benign and malignant glomerular diseases and is more diagnostic for patients with low tumor load in type. κ / λ is closely related to the prognosis of MM.