Kelly R H, Hardy T J, Shah P M
Immunol Invest. 1985 Jun;14(3):183-97. doi: 10.3109/08820138509076143.
Disease associations of clonally restricted serum immunoglobulin (Ig) abnormalities were examined using methods for detecting and characterizing homogeneous Ig that are approximately forty times more sensitive than either cellulose acetate zone electrophoresis or immunoelectrophoresis. Medical records of three hundred five patients with clonally-restricted serum immunoglobulins, including 100 monoclonal gammopathies, and 205 immune complex/oligoclonal patterns were reviewed to obtain the attending physician's discharge diagnosis. Our data confirm lymphoproliferative disorders as the most frequent cause of monoclonal gammopathy (63% of our cases). However, in contrast to earlier reports, we found little evidence to support an association between monoclonal gammopathy and non-reticular malignancy. This does not mean our patients with these disorders had normal serum immunoglobulin patterns; rather, their qualitative abnormalities were, for the most part, not monoclonal. Instead, patients with these diseases had a high incidence of serum immune complexes and their antibody excess sequelae, oligoclonal patterns. Oligoclonal responses are noteworthy because Ig products of the individual clones do not always achieve equivalent serum concentrations, nor are the various clonal products synchronized with respect to the time at which they attain peak concentration. This creates a number of problems for laboratories attempting to characterize such abnormalities; 1) some analytical methods may only be capable of detecting the dominant clone of an oligoclonal pattern, and 2) analysis of a single specimen may yield erroneous results because the unique waxing and waning kinetic pattern of oligoclonal responses may preclude identification of all components at a single time point. We conclude that benign "monoclonal" gammopathies and circulating immune complex/oligoclonal Ig abnormalities occur in the same clinical situations and may be synonymous. The sensitivity of an individual laboratory's analytical methods would then determine which name is applied.
利用检测和鉴定均一性免疫球蛋白的方法，对克隆受限血清免疫球蛋白（Ig）异常的疾病关联进行了研究，这些方法的灵敏度比醋酸纤维素区带电泳或免疫电泳高约40倍。回顾了305例克隆受限血清免疫球蛋白患者的病历，包括100例单克隆丙种球蛋白病和205例免疫复合物/寡克隆模式，以获得主治医生的出院诊断。我们的数据证实淋巴增生性疾病是单克隆丙种球蛋白病最常见的原因（占我们病例的63%）。然而，与早期报告相反，我们几乎没有发现证据支持单克隆丙种球蛋白病与非网状恶性肿瘤之间的关联。这并不意味着患有这些疾病的患者血清免疫球蛋白模式正常；相反，他们的定性异常在很大程度上不是单克隆的。相反，患有这些疾病的患者血清免疫复合物及其抗体过量后遗症（寡克隆模式）的发生率很高。寡克隆反应值得注意，因为各个克隆的Ig产物并不总是能达到相同的血清浓度，而且各种克隆产物在达到峰值浓度的时间方面也不同步。这给试图鉴定此类异常的实验室带来了一些问题：1）一些分析方法可能只能检测寡克隆模式的优势克隆，2）对单个样本的分析可能会产生错误结果，因为寡克隆反应独特的增减动力学模式可能会妨碍在单个时间点识别所有成分。我们得出结论，良性“单克隆”丙种球蛋白病和循环免疫复合物/寡克隆Ig异常发生在相同的临床情况下，可能是同义词。那么单个实验室分析方法的灵敏度将决定使用哪个名称。
