MM患者血清M蛋白轻重链的型别构成及与血清或尿液中游离轻链检出的关系

摘要

目的：探讨多发性骨髓瘤患者（M M ）血清单克隆免疫球蛋白（M 蛋白）轻、重链型别分布的规律，以及不同重链型患者血清或尿液中游离轻链的检出状况。方法对采用免疫固定电泳对312例M M患者血清M蛋白进行分析的结果（不含非分泌型）进行回顾性分析。结果在312例MM患者中，IgG型、游离轻链型、IgA 型和 IgM 型分别占62．82％、20．51％、15．38％和1．28％。IgG和IgM重链型M M患者均分别以κ轻链为主，κ∶λ＝1．55∶1．00和3．00∶1．00，而 IgA 以λ轻链为主，κ∶λ＝0．71∶1．00。Ig G型M M患者中，血液中检出游离轻链的患者占43．88％，显著高于Ig A型的20．83％和Ig M 型的25．00％（ P＝0．003、0．004）。血液中检出游离轻链的IgA型MM患者，其尿液中有70．00％亦同时出现游离轻链，这一比例显著高于IgG型的16．28％（ P＝0．000）。结论 M M患者仍以Ig G型为主，游离轻链型居于第2位。M M患者的重链分型，与血液或尿液中检出游离轻链的概率高低有关。%Objective To investigate the composition of heavy chain and light chain types of serum monoclonal immunoglobulin (M protein) in patients with multiple myeloma (MM ,excluding non‐secretory patients) and the link between different types with the occurrence of free light chain in serum or urine .Methods The results of serum and urine immunofixation electrophoresis of 312 patients with MM were retrospectively analyzed .Results Of all the 312 MM patients ,patients with M protein of IgG ,free light chain ,IgA and IgM types accounted for 62 .82% ,20 .51% ,15 .38% and 1 .28% ,respectively .The ratio of patients with IgG κtype to that of IgG λwas 1 .55∶1 .00 ,IgM κ to IgM λwas 3 .00∶1 .00 ,and IgA κ to IgA λ was 0 .71∶1 .00 ,respectively .Serum free light chain in 43 .88% of MM patients with IgG M protein could be observed ,which was significantly higher than that of patients with IgA (20 .83% ) and IgM (25 .00% )(P=0 .003 ,0 .004) .Urine free light chain could also be detected in 70 .00% of MM pa‐tients with IgA M protein whose serum free light chain was observed ,which was significantly higher than that of IgG (16 .28% ) (P=0 .000) .Conclusion The most prevalent type of MM patients is IgG type ,and the second is free light chain .The heavy chain type of M M patients is related to the probability of detection of free light chain in blood or urine .