Department of Veterans Affairs, Robley Rex Medical Center, Louisville, KY 40206, USA.
Clin Chim Acta. 2012 Nov 12;413(21-22):1800-7. doi: 10.1016/j.cca.2012.06.032. Epub 2012 Jul 3.
Polyneuropathy organomegaly, endocrinopathy, monoclonal (M) gammopathy, skin syndrome (POEMS) may be difficult to diagnose as a result of methodological and clinical idiosyncrasies. Four of eleven criteria (M-protein, VEGF, endocrinopathy and thrombocytosis/polycythemia) are closely associated with clinical laboratory testing. POEMS has been largely associated with λ-M-gammopathies. Vascular endothelial growth factor (VEGF) is a recent addition to the major diagnostic criteria. VEGF may alter vascular permeability causing some manifestations of POEMS.
Review of the literature that focuses on clinical laboratory issues--endocrinological findings, identification of monoclonal gammopathies by electrophoresis and case demonstration.
Based on the criterion of VEGF, POEMS was diagnosed in a patient with a κ-M-gammopathy.
Low-level IgA monoclonal proteins that are common in POEMS are often difficult to identify by serum electrophoresis (SPE). Immunofixation electrophoresis is required when polyneuropaties are investigated and an M-protein is not identified by SPE. VEGF may improve the sensitivity for diagnosis of POEMS and findings from capillary leak syndrome which are also associated with elevated VEGF and M-gammopathy suggests that κ-M-gammopathies may be implicated more often. It is demonstrated that due to computerized records, the laboratory practitioner is well suited to help the clinician make this complicated diagnosis.
多发性神经病、器官肿大、内分泌病、单克隆（M）γ球蛋白病、皮肤综合征（POEMS）可能由于方法学和临床特殊性而难以诊断。十一项标准中的四项（M 蛋白、VEGF、内分泌病和血小板增多/红细胞增多症）与临床实验室检测密切相关。POEMS 主要与 λ-M gammopathy 相关。血管内皮生长因子（VEGF）是主要诊断标准中的新增内容。VEGF 可能会改变血管通透性，导致 POEMS 的一些表现。
对重点关注临床实验室问题的文献进行综述，包括内分泌学发现、电泳鉴定单克隆丙种球蛋白和病例展示。
根据 VEGF 标准，诊断了一位患有 κ-M gammopathy 的 POEMS 患者。
POEMS 中常见的低水平 IgA 单克隆蛋白通常很难通过血清电泳（SPE）识别。当研究多发性神经病且 SPE 未识别出 M 蛋白时，需要进行免疫固定电泳。VEGF 可能会提高 POEMS 诊断的敏感性，以及与升高的 VEGF 和 M gammopathy 相关的毛细血管渗漏综合征的发现表明，κ-M gammopathy 可能更为常见。由于计算机记录，实验室医师非常适合帮助临床医生做出这一复杂的诊断。
