Hospital Universitario J. M. Morales Meseguer, Hospital Universitario Reina Sofía, Murcia, Spain.
Ann Med. 2009;41(7):547-58. doi: 10.1080/07853890903111000.
Monoclonal gammopathy of undetermined significance (MGUS) progresses to plasma cell dyscrasia at a rate of 1% per year. A high prevalence of MGUS has been noted in series of patients with immune disorders or chronic infections.
Retrospective cohort and a cross-sectional study to analyze the prognostic value of aberrant (CD38(+ +)CD138(+) CD19(-)CD45(weak)) to normal phenotype (CD38(+ +)CD138(+) CD19(+)CD45(+)) bone-marrow plasma cells ratio (A/N ratio) for the development of a plasma cell dyscrasia and the association with the presence of a chronic immune disorder.
A total of 322 patients were included with a median follow-up of 46 months. Analysis for progression revealed an increased A/N ratio as the main independent prognostic variable. A significant association between a reduced A/N ratio and the diagnosis of a chronic immune condition was found. Using receiver-operating characteristic analysis we created an A/N ratio range from 4 to 0.20. Values of 4 or higher define a group at high risk of progression (OR 10.7). A/N values of 0.20 or lower are associated with immune disorders or chronic infections (OR 20.9).
Extreme values of the A/N ratio seem to be related with two different conditions: high risk of progression, and immune condition-related MGUS.
意义未明的单克隆丙种球蛋白血症（MGUS）每年以 1%的速度进展为浆细胞恶性肿瘤。在一系列免疫紊乱或慢性感染患者的系列中，MGUS 的患病率较高。
回顾性队列和横断面研究，分析骨髓浆细胞异常表型（CD38(+ +)CD138(+) CD19(-)CD45(弱)）与正常表型（CD38(+ +)CD138(+) CD19(+)CD45(+)）的比值（A/N 比值）对浆细胞恶性肿瘤发展的预后价值，并与慢性免疫紊乱的存在相关。
共纳入 322 例患者，中位随访时间为 46 个月。分析进展情况发现，A/N 比值增加是主要的独立预后变量。发现 A/N 比值降低与慢性免疫疾病的诊断之间存在显著关联。通过接收者操作特征分析，我们创建了一个 A/N 比值范围从 4 到 0.20。4 或更高的值定义为进展风险高的组（OR 10.7）。0.20 或更低的值与免疫紊乱或慢性感染相关（OR 20.9）。
A/N 比值的极端值似乎与两种不同的情况有关：进展风险高，以及与免疫相关的 MGUS。
