毛细管电泳技术在多发性骨髓瘤诊断及MRD监测中的价值

摘要

目的:探讨毛细管电泳免疫分型技术在多发性骨髓瘤初诊及微小残留病变(MRD)监测中的意义.方法:采用毛细管电泳免疫分型技术对临床疑似由单克隆免疫球蛋白增多引起的肾病、血液病等初诊患者671例进行血清检测.连续追踪32例初诊诊断为多发性骨髓瘤的患者,毛细管分型电泳监测MRD,并与流式细胞仪监测结果进行对比.结果:单克隆免疫球蛋白增多者265例,阳性率39.5％,其中IgG-K型91例(34.3％),IgG-λ型57例(21.5％),lgA-K型25例(9.4％),IgA-λ型20例(7.5％),IgM-K型16例(6.0％),IgM-λ型5例(1.9％),游离K轻链型12例(4.5％),游离λ轻链型26例(9.8％),双克隆型11例(4.2％),其它型2例(0.8％).连续监测32例多发性骨髓瘤患者MRD,患者诱导化疗缓解后3个月毛细管电泳MRD监测阳性率为46.9％,流式细胞仪阳性率为75.0％,两种方法比较,差异有显著性(P＜0.05);诱导化疗缓解后6个月毛细管电泳MRD监测阳性率为28.1％,流式细胞仪阳性率为43.8％,两种方法比较无显著性差异.结论:毛细管电泳免疫分型技术对多发性骨髓瘤的诊断具有较高的敏感性及特异性,MRD监测虽不及流式细胞仪灵敏,但与流式细胞仪同时监测可减少漏检率.%Objective:To explore the clinical significance of capillary electrophoresis in the diagnosis and MRD monitoring of patients with multiple myeloma (MM).Methods:The serum of 671 patients with renal disease and blood disease doubtful caused by monoclonal immunoglobulin were extracted and detected by capillary immunoassay.We continuously followed up 32 patients with multiple myeloma.Capillary electrophoresis was used to monitor minimal residual disease,and the results were compared with flow cytometry.Results:Among all the samples,monoclonal immunoglobulin could be detected in 265 cases,the positive rate was 39.5％.It contained IgG kappa type in 91 cases(34.3％),IgG lambda type in 57 cases(21.5％),IgA kappa type in 25 cases(9.4％),IgA lambda type in 20 cases(7.5％),IgM kappa type in 16 cases(6.0％),IgM lambda type in 5 cases(1.9％),free kappa light chain type in 12 cases(4.5％) and free lambda light chain type in 26 cases(9.8％),Bi clonal type in 11 cases(4.2％),the other 2 cases(0.8％).When the 32 patients with multiple myeloma achieved complete remission after chemotherapy,we performed continuous follow-up.After three months,the MRD positive rate of capillary electrophoresis was 46.9％ and the MRD positive rate of flow cytometry was 75.0％.The difference between the two methods was significant(P ＜ 0.05).After six months,the MRD positive rate of capillary electrophoresis was 28.1％ and the MRD positive rate of flow cytometry was 43.8％.There was no statistics difference between the two methods.Conclusion:The capillary electrophoresis can diagnosis multiple myeloma with high sensitivity and specificity.Capillary electrophoresis of MRD monitoring is not as sensitive as flow cytometry,but CE and flow cytometry detection at the same time could reduce the miss rate.