Objective: To explore the clinical application value of serum light chain (sLC) in the diagnosis and therapeutic efficacy evaluation for multiple myeloma.
Methods: 46 patients with newly diagnosed multiple myeloma were selected as MM group and 50 healthy persons as control group. Rate scattering immunoturbidimetry was used to detect serum light chain and immunoglobulin (Ig) in two groups, serum protein electrophoresis was used to detect M protein by agarose gel. Then, the sensitivity and specificity of the two methods in MM diagnosis were analyzed and compared, and the significance of sLC detection in MM diagnosis were discussed. In addition, 15 MM patients after received conventional therapy were tracked, sLC levels in five different therapentic times were recorded, and the effect of sLC in efficacy evaluation of MM was analyzed.
Results: There were 11 cases of IgA type, 15 cases of IgG type, 8 cases of light chain κ type, 8 cases of light chain λ type, 2 cases of IgD type, and 2 cases of non-secretion type. The sLC-κ, sLC-λ and their ratio (including light chain type and double clone type), IgA and IgG (except IgD type), as well as albumin, beta-globulin and gamma-globulin levels showed statistically significant differences (P＜0.05) compared with the control group. The sensitivity of serum protein electrophoresis, Ig quantification, sLC and its ratio in the diagnosis of multiple myeloma were 57%, 76% and 65%, and their specificity were 83%, 61% and 90%, respectively. After the second or third chemotherapy, the sLC-κ/λ ratio gradually approached the normal range as the disease reliefes, and the sLC-κ/λ ratio continued to be on or off the line at outliers or further away from the reference value as the disease progresses in MM patients with κ type or λ type.
Conclusion: sLC detection shows positive significance in early diagnosis of multiple myeloma, SLC monitoring can be used for the efficacy evaluation for treatment of MM patients.
题目: 血清轻链在多发性骨髓瘤中的诊断及疗效评价中的价值.
目的: 探讨血清轻链（sLC）在多发性骨髓瘤（MM）中的临床诊断和疗效评估中的应用价值.
方法: 以临床初诊为MM的46例多发性骨髓瘤患者作为MM组，50例健康人作为正常对照组，对2组对象分别采用速率散射免疫比浊法检测血清轻链和免疫球蛋白（Ig），同时利用琼脂糖凝胶进行血清蛋白电泳检测M蛋白，分析比较2种方法对MM诊断的敏感度、特异度，探讨sLC检测在MM诊断中的意义；同时，对接受常规治疗的15例MM患者进行随访跟踪，记录5次不同治疗时间的sLC水平，分析sLC在MM疗效评估中的作用.
结果: IgA型11例，IgG型15例，轻链κ型8例，轻链λ型8例，IgD型2例，不分泌型2例。多发性骨髓瘤患者组与正常对照组比较，sLC-κ、sLC-λ及其比值（包括轻链型和双克隆型），IgA、IgG（免疫球蛋白除IgD型外），白蛋白、β-球蛋白、γ-球蛋白水平均有统计学差异（P＜0.05）。血清蛋白电泳、Ig定量、sLC及其比值诊断多发性骨髓瘤的灵敏度依次为：57%，76%和65%，特异度依次为：83%，61%和90%。κ型和λ型患者在第2或第3次化疗后，随着病情的缓解sLC-κ/λ逐渐趋近于正常范围，而当病情进展时，sLC-κ/λ持续在异常值或更远离于参考值的上线或下线.
结论: sLC检测对多发性骨髓瘤的诊断具有辅助作用，通过分析sLC水平及其比值的变化有助于对MM的疗效评估.