毛细管电泳在单克隆丙种球蛋白病中的应用及单克隆蛋白在多发性骨髓瘤与其他单克隆丙种球蛋白病鉴别诊断中的截断值。

Application of Capillary Electrophoresis in Monoclonal Gammopathies and the Cutoff Value of Monoclonal Protein in Differential Diagnosis of Multiple Myeloma and Other Monoclonal Gammopathies.

机构信息

Department of Clinical Laboratory, the Affiliated Hospital of Qingdao University, Qingdao, China.

Department of Clinical Laboratory, the Affiliated Hospital of Qingdao University, Qingdao, China

出版信息

Ann Clin Lab Sci. 2021 May;51(3):400-407.

PMID:34162571

Abstract

OBJECTIVE

Monoclonal protein (MP) exists in various diseases, and capillary electrophoresis (CE) has been widely used to detect MP. However, there is not much research on the application value of MP in the differential diagnosis of monoclonal gammopathies. This study aimed to explore MP's cutoff value for the differential diagnosis of multiple myeloma (MM) and other monoclonal gammopathies (MGs).

METHODS

A retrospective analysis of 8167 cases was conducted. Serum MP was detected by CE, and the patients' clinical information was collected from the clinical database of our hospital.

RESULTS

985 cases had MP with high peaks, and 91.1% were diagnosed with malignant diseases. The MP showed small peaks in 471 cases, and only 24.4% were diagnosed with malignant diseases. Among the MPs, the IgG-κ type was the most common type, followed by the IgG-λ, IgA-κ, IgA-λ, free λ light chain, IgM-κ, free κ light chain, double clone, and IgM-λ types. Differences in the MP of the IgG, IgA, IgM, and FLC types between the MM group and MGUS group were statistically different (<0.01). The MP of the IgG, IgA, and FLC types showed clear specificity and sensitivity in discriminating MM from other monoclonal gammopathies in ROC curve analysis. Serum IgM had statistical significance in the differential diagnosis between WM and other MGs (<0.01). However, there was no statistical significance in the differential diagnosis between MM and other MGs (=0.140). The cutoff values of the MP of the IgG, IgA, and FLC types were >18.67g/L, >13.86g/L, and >10.15g/L, respectively, for the differential diagnosis of MM and other MGs. The cutoff value of the MP of IgM for the WM diagnosis was >37.75 g/L.

CONCLUSION

CE has good clinical application value in the diagnosis of monoclonal gammopathies, and MP can be used in the differential diagnosis of MM and other monoclonal gammopathies.

摘要

目的

单克隆蛋白（MP）存在于多种疾病中，毛细管电泳（CE）已被广泛用于检测 MP。然而，关于 MP 在单克隆丙种球蛋白病鉴别诊断中的应用价值的研究并不多。本研究旨在探讨 MP 在鉴别诊断多发性骨髓瘤（MM）和其他单克隆丙种球蛋白病（MGs）中的截断值。

方法

回顾性分析 8167 例患者。采用 CE 法检测血清 MP，并从我院临床数据库中收集患者的临床资料。

结果

985 例 MP 有高尖峰，91.1%诊断为恶性疾病。471 例 MP 呈小峰，仅 24.4%诊断为恶性疾病。在 MPs 中，以 IgG-κ 型最常见，其次是 IgG-λ、IgA-κ、IgA-λ、游离 λ 轻链、IgM-κ、游离 κ 轻链、双克隆和 IgM-λ 型。MM 组与 MGUS 组之间 IgG、IgA、IgM 和 FLC 型 MP 的差异有统计学意义（<0.01）。ROC 曲线分析显示，IgG、IgA 和 FLC 型 MP 在鉴别 MM 与其他单克隆丙种球蛋白病方面具有明显的特异性和敏感性。血清 IgM 在 WM 与其他 MGs 的鉴别诊断中有统计学意义（<0.01）。然而，在 MM 与其他 MGs 的鉴别诊断中无统计学意义（=0.140）。MP 的 IgG、IgA 和 FLC 型截断值分别为>18.67g/L、>13.86g/L 和>10.15g/L，用于鉴别 MM 和其他 MGs。IgM 的 MP 截断值为>37.75 g/L，用于诊断 WM。