Keren D F, Warren J S, Lowe J B
Department of Pathology, University of Michigan, Ann Arbor 48109.
Clin Chem. 1988 Nov;34(11):2196-201.
Identification of monoclonal gammopathies in serum has involved electrophoresis of serum proteins, immunoelectrophoresis (IEP), and quantification of IgG, IgA, and IgM. Recent innovations in technology--including high-resolution electrophoresis (HRE), immunofixation (IFX), and quantification of kappa- and lambda-containing immunoglobulins--allow for more rapid and precise assessment of serum for monoclonal proteins. We present a series of guidelines to determine when high-resolution electrophoresis and quantification of immunoglobulins (including kappa and lambda) are sufficient and when additional IFX is required to characterize the monoclonal gammopathy. Of the samples studied, 88% were correctly diagnosed by HRE with quantification of immunoglobulins and kappa/lambda; only 12% required that IFX be performed. The guidelines allow us to detect monoclonal gammopathies quicker and more efficiently by avoiding redundant IEP or IFX testing. For the vast majority of cases, these guidelines allow for a correct diagnosis within one day. After one year of follow-up since completion of the study, no undetected cases of monoclonal gammopathy have eventuated.
血清中单克隆丙种球蛋白病的鉴定涉及血清蛋白电泳、免疫电泳（IEP）以及IgG、IgA和IgM的定量分析。技术上的最新创新——包括高分辨率电泳（HRE）、免疫固定电泳（IFX）以及含κ和λ免疫球蛋白的定量分析——使得对血清中的单克隆蛋白进行更快速、精确的评估成为可能。我们提出了一系列指导原则，以确定何时高分辨率电泳和免疫球蛋白（包括κ和λ）定量分析就足够了，以及何时需要额外进行IFX来鉴定单克隆丙种球蛋白病。在所研究的样本中，88%通过HRE结合免疫球蛋白及κ/λ定量分析得到了正确诊断；只有12%的样本需要进行IFX检测。这些指导原则使我们能够通过避免冗余的IEP或IFX检测，更快速、高效地检测单克隆丙种球蛋白病。对于绝大多数病例，这些指导原则能在一天内做出正确诊断。自研究完成后的一年随访期内，未出现未被检测到的单克隆丙种球蛋白病病例。
