Hutchison Colin A, Cockwell Paul, Cook Mark
Renal Institute of Birmingham, University Hospital and University of Birmingham, Birmingham, UK.
BMC Clin Pathol. 2012 Aug 9;12:12. doi: 10.1186/1472-6890-12-12.
The development of serum immunoassays for the measurement of immunoglobulin free light chains has led to a paradigm shift in the diagnosis, assessment and monitoring of patients with plasma cell dyscrasias. The impact of these immunoassays which employ polyclonal antibodies was most notable for those patients who were previously classified as non-secretory multiple myeloma. Recently new monoclonal antibody based assays have become available. The purpose of this study was to compare the diagnostic sensitivity of these new assays with those already in clinical practice.
Sera from 30 patients who present with severe acute kidney injury and multiple myeloma were identified for analysis. A head to head comparison of the two commercially available free light chains assays was then undertaken to determine if their diagnostic sensitivity and specificity were comparable.
In this first assessment of the utility of these new assays, we found that one of 17 patients with a lambda monoclonal free light chain resulting in acute kidney injury were not identified and a further 12% of patients were wrongly classified as having levels below those associated with disease specific acute kidney injury.
These results suggest that caution should be applied to the use of new free light chain assays in the assessment of patients with a monoclonal gammopathy.
用于测量免疫球蛋白游离轻链的血清免疫测定法的发展，已导致浆细胞异常增生患者的诊断、评估和监测发生了范式转变。这些采用多克隆抗体的免疫测定法对那些先前被归类为非分泌型多发性骨髓瘤的患者影响最为显著。最近，基于单克隆抗体的新测定法已问世。本研究的目的是比较这些新测定法与临床实践中现有测定法的诊断敏感性。
确定30例患有严重急性肾损伤和多发性骨髓瘤患者的血清进行分析。然后对两种市售游离轻链测定法进行直接比较，以确定它们的诊断敏感性和特异性是否相当。
在对这些新测定法效用的首次评估中，我们发现，17例因λ单克隆游离轻链导致急性肾损伤的患者中有1例未被识别，另有12%的患者被错误分类为水平低于与疾病特异性急性肾损伤相关的水平。
这些结果表明，在评估单克隆丙种球蛋白病患者时，应谨慎使用新的游离轻链测定法。
