78例多发性骨髓瘤的实验室诊断分析与评价(1)
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[摘要] 目的：探讨血清免疫固定电泳、血清蛋白电泳、免疫球蛋白测定在多发性骨髓瘤中的诊断价值。方法：78例多发性骨髓瘤患者的血清同时做免疫固定电泳、血清蛋白电泳和免疫球蛋白含量测定进行分析比较。结果：78例免疫固定电泳全为阳性，72例血清蛋白电泳出现M带。免疫分型IgG占52.6%，IgA占29.5%，IgM占1.3%，游离轻链型占15.1%，双链型占2.5%。其中IgG、IgA型以κ型为主，但首诊以肾功能不全入院的患者中以λ链为主。免疫球蛋白和轻链测定显示同型免疫球蛋白和轻链的含量明显升高并常伴有其他组分异常。结论：免疫固定电泳能对M蛋白进行准确分型鉴定、特异性好、灵敏度高，对多发性骨髓瘤的临床诊断及治疗有重要意义，同时可减少漏诊、误诊。
[关键词] 多发性骨髓瘤；免疫固定电泳；免疫球蛋白；血清蛋白电泳
[中图分类号] R446.6[文献标识码] B[文章编号] 1673-7210(2010)10(b)-064-02
Laboratory diagnosis and evaluation of 78 cases of multiple myeloma
HUANG Cuibo
(Department of Clinical Laboratory, the National Hospital of Guangxi Zhuang Autonumous Region, Nanning 530001, China)
[Abstract] Objective: To evalute the diagnostic value of serum immunofixation electrophoresis (IFE), serum protein electrophoresis and immunoglobulin assay in the mutiple myeloma (MM). Methods: Serum sample from 78 patients with MMwere detected and compared by IFE, serum protein electrophoresis and immunoglobulin assay. Results: 78 patients with MM of IFE were positive. M belt appeared in 72 serum samples, in which IgG, IgA, IgM, free light chain and double chain type were 52.6%,29.5%,1.3%,15.1% and 2.5%. The major M protein of IgG and IgA was κ type and 12 patients with renal insufficiency were subject to λ type. Content of immunoglobulin and light chain type increased obviously, accompanying with else abnormal component. Conclusion: Serum protein immunofixation electrophoresis can be valuable to the diagnosis of MM with accurate type for M protein, good specificity, high sensibility, at the same time decrease missed diagnosis and misdiagnosis.
[Key words] Multiple myeloma; immunofixation electrophoresis; Immunoglobulin; Serum protein electrophoresis
M蛋白是多发性骨髓瘤(MM)的特征之一，它是由单细胞系浆细胞株所合成的单一免疫球蛋白，免疫固定电泳(IFE)是免疫球蛋白增殖病鉴定的一项新技术，它包括琼脂凝胶电泳和免疫沉淀两个过程的操作，它能对M蛋白进行准确分型和鉴定。笔者将78例多发性骨髓瘤患者血清进行血清蛋白电泳、免疫固定电泳、免疫球蛋白测定，现分析如下：
1 材料与方法
1.1 标本来源
2007年1月～2009年12月在我院住院的多发性骨髓瘤患者78例，按WHO制订的诊断标准确诊，其中，男54例，女24例；男女比例为2.25∶1；最小年龄33岁，最大年龄83岁，中位年龄57岁。其中12例以肾功能不全入院，后确诊为多发性骨髓瘤。
1.2 方法
①血清蛋白电泳：采用法国Sebia Hydrasys全自动电泳分析系统进行电泳和扫描。②免疫固定电泳：采用法国Sebia Hydrasys全自动电泳分析系统及原装配套试剂盒，取按操作规程稀释的患者血清10 μl加入点样梳内，经琼脂糖凝胶板电泳后，在每份样本的6个泳道上分别加入抗IgG，抗IgA，抗IgM，抗KAP，抗LAM血清10.5 μl。孵育，固定，沉淀蛋白，吸去多余的血清，干燥，酸紫染色，脱色，烘干，观察结果。③免疫球蛋白含量测定：采用美国德灵公司生产的BN2特种蛋白分析仪及原装配套试剂盒 ......
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