血清果糖胺检测在IgA型多发性骨髓瘤中的临床价值

摘要

目的:探讨血清果糖胺(fructosamine,FMN)检测在多发性骨髓瘤(MM)临床分型以及在IgA型MM患者分期、疗效评估及预后中的价值.方法:采用硝基四氮唑蓝比色法检测62例IgA型MM患者、65例IgG型MM患者、24例IgM型MM患者FMN水平,分析其在各型MM中的差异,同时分析其与IgA型MM患者临床分期、疗效间的关系以及对患者总生存期(OS)的意义.结果:IgA型患者FMN水平明显高于IgG型和IgM型MM患者.DS分期中Ⅲ期患者FMN水平明显高于Ⅱ期患者,Ⅱ期患者FMN水平明显高于Ⅰ期患者,且差异有统计学意义(P＜0.05).ISS分期中Ⅲ期患者FMN水平也明显高于Ⅱ期患者,Ⅱ期患者FMN水平也明显高于Ⅰ期,差异有统计学意义(P＜0.05).IgA型MM患者经治疗后,获得完全缓解(CR)和非常好的部分缓解(VGPR)患者的FMN水平较治疗前明显降低,部分缓解(PR)的患者FMN水平较治疗前降低,获得PR疗效以下的患者FMN水平较治疗前有所上升.FMN水平正常的患者具有较好的OS,而FMN水平高的患者OS明显缩短.结论:血清FMN在IgA型MM中显著升高,与患者分期有一定的相关性,治疗后FMN水平正常初步提示IgA型MM的预后较好.%Objective.To investigate the value of serum fructosamine (FMN) measurement in clinical typing and staging of multiple myeloma(MM) as well as evaluation of curative efficacy and prognosis of IgA type MM.Methods:The levels of FMN were detected by nitro-blue-tetrazolium colorimetric method in 62 IgA type MM patients,65 IgG type MM patients,24 IgM type MM patients.The difference between the serum FMN levels and different MM types and its relationship with IgA type MM,patients' stages,efficacy and as well as,the effect of FMN level on overall survival(OS) time of IgA type MM patients were analyzed.Results:FMN level of IgA type patients was obviously higher than that of IgG type and IgM type patients.Patients of DS stage Ⅲ had higher FMN level than that of stage Ⅱ,and patients of DS stage Ⅱ had higher FMN level than that of stage Ⅰ,the differences were statistical significant (P ＜ 0.05).Patients of ISS stage Ⅲ also had higher FMN level than that of stage Ⅱ,and patients of ISS stage Ⅱ also had higher FMN level than that of stage Ⅰ,the differences were statistical significant(P ＜0.05).After treatment,FMN level of patients obtained complete remission (CR) or very good partial remission (VGPR) obviously decreased,FMN level of patients obtained partial remission (PR) decreased,FMN level of patients obtained less than PR increased.Patients with normal FMN level had longer OS time,while patients with high FMN level had obviously short OS time.Conclusions:Serum FMN is obviously elevated in the IgA type MM,there is a certain association between staging and serum FMN level,the IgA type MM patients with FMN normalization after treatment have better prognosis.