多发性骨髓瘤患者M蛋白水平的回顾性分析

目的回顾分析113例多发性骨髓瘤(multiple myeloma,MM)患者的血清免疫固定电泳(IFE)及血清免疫球蛋白(Ig)的M蛋白的测定结果,探讨M蛋白在MM诊断中的应用。方法对113例确诊为MM的患者同时做免疫固定电泳(IFE)、血清蛋白质电泳和Ig定量测定,并对结果进行分析比较。结果 113例MM患者年龄≥50岁者居多(95人),50岁以下较少(18人),男性略多于女性(66∶47);IgG类MM所占比例最高(51.3%),IgM类MM最低(4.4%);无论是Kappa型还是Lambda型M蛋白,κ/λ比值均显著异常。各指标检出M蛋白的阳性率κ/λ最高(73.5%),血清Ig定量最低(47.8%)。结论 M蛋白分类和分型对临床MM的诊断和治疗可提供重要依据。     

多发性骨髓瘤血清蛋白电泳与免疫学分型

目的对38例多发性骨髓瘤(MM)患者血清蛋白电泳、免疫电泳及免疫球蛋白进行定量分析,以探讨M蛋白、MM型别分布及其在MM中的临床诊断价值。方法血清蛋白和免疫电泳采用全自动琼脂糖凝胶电泳仪进行电泳和扫描;免疫球蛋白定量采用Beckman CS-免疫化学分析仪,以全自动方式进行速率散射比浊分析,测各样本的免疫球蛋白(IgG、IgA、Ig M)含量。结果38例MM全部检出M带,22例MM尿液检出本-周氏蛋白,检出阳性率为57.90%。血清免疫电泳分型IgGκ型14例,占36.84%;IgGλ型10例,占26.32%;IgAκ型5例,占13.16%;IgAλ型6例,占15.79%;Ig Mλ型3例,占7.89%,为最少。结论血清蛋白及免疫电泳能快速、准确地进行MM分型,对MM的诊断、病情判断、治疗及预后评估均具有重要的临床价值。     

107例多发性骨髓瘤M蛋白检测与免疫学分型分析

目的 探讨免疫固定电泳技术在鉴定M蛋白上的应用.方法 采用血清蛋白电泳技术、血清免疫固定技术(IFE)检测107例MM患者血清M蛋白.结果 107例MM患者中97例血清蛋白电泳检出M蛋白,107例免疫固定电泳均检出M蛋白.M蛋白IFE分型结果为IgG型63例,其中IgG κ型29例,IgG λ型34例;IgA型25例,其中IgA κ型11例,IgA λ型14例;IgM型3例,其中IgM κ型1例,IgM λ型2例;单纯轻链型15例,其中κ型2例,λ型13例.60例MM患者中有39例检出尿本-周氏蛋白,其中,12例为κ型,27例为λ型.三种方法中血清免疫固定电泳的检出率最高,血清蛋白电泳次之,尿液本周氏蛋白电泳检出率最低(P<0.01).结论 采用免疫固定电泳技术,操作简单、快速,灵敏度高,沉淀带容易识别,是鉴定各类型M蛋白的较准确、直观的有效方法.     

Igκ、Igλ及Igκ与Igλ比值在多发性骨髓瘤诊断中的作用

目的探讨Igκ、Igλ及Igκ与Igλ比值在多发性骨髓瘤(MM)临床诊断中的作用。方法采用HevyliteTM法测定122例MM患者及30例健康者血清Igκ、Igλ水平并计算其比值,同时对MM患者血清进行免疫固定电泳。结果血清免疫固定电泳分型:κIgG型MM 26例(21.31%),λIgG型MM 58例(47.54%);κIgA型MM 14例(11.48%),λIgA型MM 18例(14.75%);κIgM型MM 4例(3.28%),λIgM型MM 2例(1.64%)。κIgG型MM患者血清IgGκ水平中位数为36.900g/L,IgGκ与IgGλ比值的中位数为97.300,均明显高于健康对照组,差异有统计学意义(P0.05);与之相反,IgGλ水平中位数为0.380g/L,明显低于健康对照组(34.900g/L),差异有统计学意义(P0.05)。λIgG型MM患者血清中IgGλ水平中位数为34.900g/L,明显高于健康对照组(3.420g/L),差异有统计学意义(P0.05);与之相反,IgGκ水平中位数为0.495g/L,IgGκ与IgAλ比值中位数为0.016,均明显低于健康对照组,差异有统计学意义(P0.05)。IgA型MM患者血清中IgAκ、IgAλ水平及IgAκ与IgAλ比值与健康对照组比较,与IgG型MM患者呈相同的变化模式。结论 Igκ、Igλ及Igκ与Igλ比值在MM临床诊断中具有重要价值。     

42例多发性骨髓瘤的血清免疫电泳分析

目的应用免疫固定电泳检测多发性骨髓瘤（MM）患者血清M蛋白并进行分型。方法对42例MM患者血清进行血清蛋白电泳、免疫固定电泳及免疫球蛋白（IgG、IgA、IgM）定量分析。结果42例MM患者中：40例MM检出M带,免疫固定电泳分型：IgGκ型16例（38.1%）,IgGλ型10例（23.8%）;IgAκ型5例（11.9%）,IgAλ型3例（7.1%）;κ轻链型4例（9.5%）,λ轻链型2例（4.8%）;不分泌型2例（4.8%）。免疫球蛋白检测表明同型免疫球蛋白含量显著升高并常伴有非对应组分的偏低。结论免疫固定电泳检测MM患者的M蛋白特异性好、灵敏度高,对MM的诊断分型和临床分期及预后判断具有重要意义。     

42例多发性骨髓瘤的血清免疫电泳分析

目的应用免疫固定电泳检测多发性骨髓瘤（MM）患者血清M蛋白并进行分型。方法对42例MM患者血清进行血清蛋白电泳、免疫固定电泳及免疫球蛋白（IgG、IgA、IgM）定量分析。结果42例MM患者中：40例MM检出M带,免疫固定电泳分型：IgGκ型16例（38.1%）,IgGλ型10例（23.8%）;IgAκ型5例（11.9%）,IgAλ型3例（7.1%）;κ轻链型4例（9.5%）,λ轻链型2例（4.8%）;不分泌型2例（4.8%）。免疫球蛋白检测表明同型免疫球蛋白含量显著升高并常伴有非对应组分的偏低。结论免疫固定电泳检测MM患者的M蛋白特异性好、灵敏度高,对MM的诊断分型和临床分期及预后判断具有重要意义。     

免疫固定电泳在多发性骨髓瘤患者实验室诊断中的应用

目的 对150例多发性骨髓瘤患者免疫球蛋白定量、血清蛋白电泳争免疫固定电泳结果进行分析,探讨免疫固定电泳在M蛋白血症诊断中的作用.方法 免疫球蛋白定量利用免疫散射比浊法,测定免疫球蛋白IgG,IgA,IgM和kappa,lambda轻链的浓度;血清蛋白电泳和免疫固定电泳采用Helena公司的Spire3000全自动电泳仪及扫描仪进行.结果 150例多发性骨髓瘤患者有138例血清蛋白电泳有M带,免疫固定电泳150例全部检出M带;分型结果显示以IgGλ型最多(58例,占38.7%);12例经血清蛋白电泳未检出M带而免疫固定电泳检出M带的患者中,有10例为轻链病患者.结论 免瘦固定电泳特异度和敏感度较血清蛋白电泳高.对于多发性骨髓瘤的实验室诊断特别是轻链病的诊断具有重要价值.     

IgA型多发性骨髓瘤分型特征及其双M蛋白来源分析

目的:探讨IgA型多发性骨髓瘤(MM)患者血清中出现双M蛋白的原因.方法:利用免疫固定技术成功筛查出4l例IgA型MM患者,分析其血清和尿液免疫固定电泳等实验室特征,并将其中18例在免疫固定电泳结果中出现双M蛋白的患者血清与5%巯基乙醇按3∶1的比例混匀静置15 min后,再按免疫固定电泳方法对处理血清进行M蛋白检测,对比血清处理前后的免疫固定电泳特征.结果:41例IgA型MM患者中,属κ轻链的有20例,占48.8%;属λ轻链的有21例,占51.20%;7例患者血清中出现游离轻链;24例患者的尿液出现本周蛋白;18例患者血清出现双M蛋白,占43.9%,经处理后免疫固定电泳结果显示,所有患者血清由原来的双M带变成一条M带.结论:IgA型MM患者其免疫固定电泳结果容易出现双M带,其中有一条M带是由单体IgA组成,另一条由二聚体IgA组成,其来源是由单株克隆性骨髓瘤细胞分泌的.     

免疫固定电泳和免疫球蛋白含量在多发性骨髓瘤诊断中价值

目的探讨免疫固定电泳技术和免疫球蛋白含量在多发性骨髓瘤(multiple myeloma,MM)诊断和分型中的应用价值。方法 140例MM患者为MM组,对其血清和尿液进行免疫固定电泳检查,免疫固定电泳采用琼脂糖电泳和免疫固定技术。选择同期体检健康者32例为正常对照组,采用速率散射比浊法检测2组血清免疫球蛋白(IgG、IgM、IgA)含量。结果 MM组患者血清经免疫固定电泳后均呈现浓集条带,M蛋白检出率为100.0%,IgG型92例(65.7%),其中IgGκ型61例,IgGλ型31例;IgM型28例(20.0%),其中IgMκ型19例,IgMλ型9例;IgA型20例(14.3%),其中IgAκ型9例,IgAλ型11例;尿液经免疫固定电泳后呈现明显浓集条带患者89例,M蛋白检出率为63.6%;免疫球蛋白含量检测显示,MM组IgG型患者IgG含量[(34.92±21.02)g/L]明显高于对照组[(11.62±6.38)g/L],IgM[(0.65±0.42)g/L]和IgA[(1.01±0.86)g/L]含量明显低于对照组[(1.23±0.56)、(2.31±1.48)g/L](P0.05);IgM型患者IgM含量[(19.50±13.20)g/L]明显高于对照组,IgG[(7.85±6.62)g/L]和IgA[(1.42±0.77)g/L]含量明显低于对照组(P0.05);IgA型患者IgA含量[(15.00±11.00)g/L]明显高于对照组,IgG[(6.52±4.86)g/L]和IgM[(0.52±0.33)g/L]含量明显低于对照组(P0.05)。结论免疫球蛋白含量可协助诊断MM,采用免疫固定电泳技术对M蛋白进行分型和鉴定,对MM的诊断分型及预后判断有重要意义。     

血清蛋白电泳在M蛋白相关性疾病中的临床诊断价值

目的探讨琼脂糖凝胶血清蛋白电泳(AGE)在M蛋白相关性疾病中的临床诊断价值。方法对江苏省徐州市第一人民医院门诊及住院患者532例采用琼脂糖凝胶电泳法做AGE,对检出M蛋白带的43例样本,先做免疫固定电泳分型,再做免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)测定、尿本-周氏蛋白定量试验、红细胞沉降率、尿蛋白电泳、血生化钙磷以及蛋白的测定等实验室检查,分析AGE对M蛋白相关疾病的诊断意义。结果 43例在AGE中出现不同位置的M蛋白带,结合其临床表现,诊断出多发性骨髓瘤(MM)39例,巨球蛋白血症3例,POEMS综合征1例。其中39例MM患者中大于或等于54岁者居多(32例),男性略多于女性(23∶16)。IgG类MM所占比例最高(58.10%),IgM类MM最低(4.20%)。对骨髓瘤的诊断,电泳出现M蛋白带的阳性率为91.9%,总蛋白大于85g/L,占71.7%,球蛋白大于40g/L,占87.1%,本-周氏蛋白定量试验阳性率76.9%,红细胞沉降率增快,占100%,lgG升高者占89.2%。尿蛋白电泳中发现M蛋白阳性率79.4%。结论 AGE有助于M蛋白相关疾病的筛查、鉴别和诊断。     

IgD型多发性骨髓瘤患者实验室检查结果分析

目的 IgD型多发性骨髓瘤患者临床上较为少见,通过实验室检查,以求发现其特点,避免漏诊。方法分别收集20例本实验室检测到的IgD型I、gG型I、gA型I、gM型多发性骨髓瘤患者的实验室检查结果,分析IgD型与其它较为常见类型的多发性骨髓瘤患者实验室检查结果的异同。结果 IgD型多发性骨髓瘤患者的免疫球蛋白定量结果显示,IgGI、gA和IgM含量均减低者有18例占90%,其余两例3种免疫球蛋白含量处于正常下限。轻链定量发现,20例IgD型多发性骨髓瘤患者有19例为IgD型λ轻链型,占95%,而IgD型κ轻链型仅1例,且20例中有19例是轻链比值异常的。IgD型多发性骨髓瘤患者的血清蛋白电泳阳性率与其余类型无显著差异（P〉0.05）;免疫固定电泳显示IgD泳道有特异性的抗原抗体沉淀带。结论如实验室检查发现患者免疫球蛋白IgGI、gA和IgM含量均减低、轻链比值异常、血清蛋白电泳出现阳性条带,要高度怀疑其为IgD型多发性骨髓瘤,免疫固定电泳时务必加IgD泳道,以避免IgD型多发性骨髓瘤的漏诊。     

免疫固定电泳对多发性骨髓瘤的诊断价值

目的：探讨免疫固定电泳（IFE）在多发性骨髓瘤（MM）诊断中的价值。方法采用法国Sebia公司生产的Hydarsys2琼脂糖凝胶电泳仪,对临床上有检测需求的患者血清进行IFE,并回顾性分析其相关实验室检查资料。结果155例患者的血清IFE检测结果中,67例阳性,其中经临床诊断证实的MM51例。IFE对MM诊断的灵敏度和特异度分别为69．9％、80．5％。51例IFE阳性的MM患者中,以免疫球蛋白（Ig）Gκ型和λ型为主,分别占19．61％、27．45％,但其余各型均有分布。51例IFE阳性MM患者病例资料回顾性分析结果显示,由于原发疾病被贫血、骨痛等首发症状掩盖,患者常会就诊于其他科室。结论IFE对MM的准确诊断、疗效监测、预后判断具有重要的临床意义。     

Immunoglobulins on the surface of lymphocytes. IV. Distribution in hypogammaglobulinemia, cellular immune deficiency, and chronic lymphatic leukemia

The distribution of peripheral blood lymphocytes that contain surface Ig has been studied by means of immunofluorescence in humans. Normal individuals, individuals with sex-linked and acquired agammaglobulinemia, selective IgA deficiency, cellular immune deficiencies, and individuals with chronic lymphatic leukemia (CLL) were studied. Approximately 28% of the peripheral blood lymphocytes from normal individuals contained surface Ig. On an average 15% contained IgG, 6%, IgA, and 8%, IgM; and the kappa: lambda ratio was 2:1. Lymphocytes from patients with CLL appeared to be "monoclonal" in that the cells from a given individual had a single Ig associated with them (e.g., kappa IgM). In three-quarters of the cases the H chain class was IgM; in the remaining one-quarter no H chain could be detected on the cell surface. The L chain class was kappa in 12 cases and lambda in 8. Four patients with sex-linked agammaglobulinemia and one with "acquired" agammaglobulinemia had markedly decreased numbers of cells with surface Ig (0-4%). In contrast, the three patients with selective IgA deficiency and no detectable serum IgA contained normal numbers of cells (6-8%) with surface IgA. Five patients with cellular deficiency states, including two with Wiskott-Aldrich syndrome, contained a normal or low percentage of cells with surface Ig.     

血清免疫固定电泳、蛋白电泳、免疫球蛋白及轻链定量在诊断多发性骨髓瘤中的临床应用

目的 探讨血清免疫固定电泳(IFE)、蛋白电泳(SPE)和免疫球蛋白定量在多发性骨髓瘤(MM)诊断中的作用。方法 选择2012年6月～2013年12月北京积水潭医院符合MM诊断标准的MM患者192例为研究对象,选择同期健康体检者30例为对照组,对MM患者进行免疫固定电泳、血清蛋白电泳和免疫球蛋白及轻链定量检测并对结果进行分析。结果 192例MM患者有120例血清蛋白电泳检出M带,检出率为62.5%; 免疫固定电泳174例检出M带,检出率为90.6%; 分型结果显示以IgG型最多(106例,55.2%),其中IgG-λ型66例(34.4%); IgA型次之(36例,18.8%),轻链型最低(24例,12.5%)。免疫球蛋白、轻链定量测定结果显示,在各型MM患者血清中出现相应免疫球蛋白及轻链的变化,与正常对照组比较差异具有统计学意义(P<0.05),检出率为67.7%(130/192)。无论是κ型还是λ型M蛋白,κ/λ比值均具有明显差异(P<0.05),检出率为85.4%(164/192)。结论 免疫固定电泳、免疫球蛋白及轻链定量、κ/λ比值测定等免疫学检测在MM诊断中有较好的检出率,能及时为临床提供有效的诊疗指标,减少误诊和漏诊的发生率。     

20例初诊多发性骨髓瘤血清游离轻链测定及其临床意义

本研究测定多发性骨髓瘤（multiple myeloma，MM）患者血清游离轻链（serum free light chain，sFLC）数值，并与血清总轻链（游离＋结合）比较，探讨sFLC测定在MM患者中的临床意义。应用免疫比浊法测定20例初治MM患者及20例正常对照人群sFLC数值，同期测定患者血清总轻链数值，计算sFLC及血轻链结果的K／h比率，其中18例行免疫固定电泳（immunofixation electrophoresis，IFE）检查。结果表明：20例多发性骨髓瘤患者sFLC数值及K／h比值较正常人群均明显异常（P〈0．01），其敏感性明显高于血清轻链（P〈0．01）。结论：应用免疫比浊法测定sFLC并结合K／h比率在MM诊断中有重要的价值，sFLC检测可作为MM诊断的重要指标之一。     

The secretion of monoclonal immunoglobulins in chronic lymphoproliferative diseases

Altogether 74 patients (57 with CLL; 12 with lymphocytomas including 7 with generalization of disease; 5 with hairy cell leukemia) were examined to detect the secretion of serum monoclonal immunoglobulins (Ig) and Bence Jones (BJ) protein. Electrophoresis of the serum in agarose gel, radial immunodiffusion and immunoelectrophoresis as well as isotachophoresis with immune development for identification of minimal amounts of BJ protein in urine were employed. Monoclonal Ig in the serum and urine (IgG lambda + BJ lambda and IgA kappa + BJ kappa) were found in 2 CLL patients. BJ protein only was revealed in 40.5% of the examinees (kappa:lambda = 4.5:1). Direct correlation between the level of BJ protein secretion and tumor mass was shown. Effective therapy caused the reduction (but not disappearance) of BJ protein in urine. During a 2-year study BJ protein secretion was undetectable in the group of nonsecreting patients with a large tumor mass. Prospects of the use of the results obtained are under discussion.     

免疫球蛋白定量检测及蛋白电泳在少见型多发性骨髓瘤诊断中的应用

目的探讨免疫球蛋白定量检测、血清蛋白电泳及免疫固定电泳在少见型多发性骨髓瘤(MM)诊断中的应用及诊断价值。方法收集2014~2015年该院31例少见型MM瘤患者,其中λ轻链型22例,κ轻链型7例,λ轻链及IgDλ双克隆型2例。空腹采集静脉血3mL,分离血清,检测免疫球蛋白定量、血清蛋白电泳及免疫固定电泳,评价其在少见型MM中的诊断价值。结果血清蛋白电泳检测到M蛋白的阳性率29.03%,Durie-Salmon分期临床Ⅱ期与Ⅲ期M蛋白水平比较,差异具有统计学意义(P0.05);少见型MM与IgGκ型的IgG及IgM比较,差异具有统计学意义(P0.05);与IgAκ型的IgA及IgM比较,差异具有统计学意义(P0.05)。结论免疫球蛋白定量和免疫固定电泳可作为少见型MM患者M蛋白的筛查方法,血清蛋白电泳则可对MM患者的临床分期和疗效起到指导价值。     

Light chain ratios of serum immunoglobulins in disease

We have determined the individual kappa (kappa)/lambda (lambda) ratios of serum IgG, IgA, and IgM in normal subjects and patients with rheumatoid arthritis, systemic lupus erythematosus, hepatic cirrhosis and IgA nephropathy--40 in each group. Serum samples were first screened by agarose electrophoresis to exclude paraproteinaemia. Concentrations of IgG, IgA, and IgM were determined by enzyme-linked immunosorbent assay (ELISA). The kappa and lambda chain concentrations of each immunoglobulin class were assayed by an ELISA method first developed by us for the determination of kappa/lambda ratios. Our results showed that kappa/lambda ratios of serum IgA and IgM were significantly different from that of IgG in normal subjects and the 4 groups of patients studied (p less than 0.01). The kappa/lambda ratios of individual immunoglobulins in patients with rheumatoid arthritis, systemic lupus erythematosus and liver cirrhosis were similar to those of normal subjects. However, patients with IgA nephropathy displayed a distinctly lower IgA kappa/lambda ratio, suggesting a unique antibody response in the immunopathogenesis of this disease.     

A new approach for rapid detection and typing of serum monoclonal components

When used independently, none of the routine methods to explore serum monoclonal components (MC), including: serum protein electrophoresis (SPE), immunoelectrophoresis (IEP), kappa to lambda ratio (KLR) and immunofixation (IFE), provides a comprehensive quantitative and qualitative identification of the MC. In the past few years the concept of 'protein profile', based on immunonephelometric quantifications of serum proteins, has become widely used. It consists of a qualitative and quantitative graphic representation of numerous serum proteins including immunoglobulins. Aim of study was to develop a multidimensional model based exclusively on protein profiles labeled the protein profile prediction method (PPPM) to improve routine MC detection and typing. Serum samples from 127 hospitalized patients and 99 healthy blood donors were submitted to all of the following: SPE, IFE, KLR and a protein profile (which included IgM, IgA, IgG, kappa and lambda chain detections and quantification). The presence of a MC using IFE was chosen as the gold standard. Healthy donors and patients were randomly divided into two groups defined as testing and validation groups. A logistic model was designed based on the protein profiles of the testing group leading to the determination of a threshold value (called Z(r)) for MC detection. It was then tested to detect MC in the validation group. Using IFE, 73 MC were found in the 127 hospitalized patients. Using the threshold value for MC detection of Z(r)=1.86, the PPPM showed greater sensitivity (94.6%) in detecting a MC compared to either SPE (64.8%) or KLR (89.2%). This result was obtained without diminished specificity (80.8%). The association of SPE or KLR to PPPM did not significantly increase the sensitivity of the PPPM. In the validation group, for samples which had a high predictive probability of a MC using PPPM, the correct MC typing was identified in up to 77% of sera using PPPM only. These results may be interesting in helping to determine when supplementary IFE analysis is required to qualitatively analyze a MC. PPPM allows MC detection with great sensitivity. The immune protein profile dramatically increases the sensitivity of either SPE and/or KLR in detecting MC and may also allow heavy and light chain typing.