Study on the Value of Serum Double M Protein Analysis and Laboratory Index Detection in Predicting the Curative Effect of Bone Marrow Transplantation in IgA-MM Patients
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维普
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目的 探讨IgA型多发性骨髓瘤(IgA multiple myeloma,IgA-MM)患者血清双M蛋白分析与实验室指标检测对骨髓移植疗效预测价值.方法 选择2019年1月～2022年1月于中国人民解放军中部战区总医院收治的60例出现双M条带的IgA-MM患者为研究对象,比较患者血清蛋白电泳及免疫固定电泳(immunofixation electrophoresis,IFE)图谱资料;采用2-巯基乙醇(2-dimercaptoethanol,2-DE)处理IgA-MM双M蛋白带的血清,IFE鉴定双M蛋白带;比较两种双M蛋白类型患者免疫学试验指标,包括免疫球蛋白A(immunoglobulin A,IgA)、免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白 M(immunoglobulin M,IgM)、血清游离轻链(serum free light chain,sFLC)和本周蛋白(Bene Jone protein,BJP);并且比较二种双M蛋白类型患者的常规实验指标;对两种IgA型双M蛋白血症骨髓瘤多发性骨髓瘤国际分期系统(international staging system,ISS)分期及疗效进行比较;采用Kaplan-Meier法和LOG-rank检验分析两种双M蛋白类型的患者生存率.结果 IFE显示,单克隆轻链型和IgA聚合体型为IgA-MM血清双M蛋白带的两种类型.单克隆轻链型患者相较于聚合体型sFLC(2 970.14±876.82 mg/L vs 118.68±74.10 mg/L)及BJP(6.22±3.01 g/L vs 0.55±0.12g/L)水平更高,差异具有统计学意义(t=21.684,12.659,均P＜0.05);单克隆轻链型患者相较于聚合体型血清 β2-微球蛋白(β 2-microglobulin,β 2-MG)(7.88±2.14 mg/L vs 4.65±1.56 mg/L)、血清钙(calcium,Ca)(2.64±0.24 mmol/L vs 2.32±0.20mmol/L)、肌酐(serum creatinine,Scr)(182.85±64.23 μmol/L vs 90.52±42.20 μmol/L)水平升高(t=21.684,120.659,6.400,5.193,6.473),血红蛋白(hemoglobin,Hb)(74.32±19.44 g/L vs 90.75±15.52 g/L)、清蛋白(albumin,Alb)(28.42±3.64 g/L vs 31.72±4.96 g/L)水平降低(t=3.386,2.428),差异具有统计学意义(均P＜0.05);与IgA聚合体型患者相比,单克隆轻链型患者ISS分期更高、疗效更低(t=11.827,4.519,均P＜0.05);生存分析结果显示,IgA聚合体型相较于单克隆轻链型生存率更高(x2=4.482,P＜0.05).结论 IgA型双M蛋白的两种类型在疗效和预后不尽相同,故鉴定IgA-MM双M蛋白带类型尤为重要.
Objective To investigate the value of serum double M protein analysis and laboratory index detection in predicting the efficacy of bone marrow transplantation in patients with IgA multiple myeloma(IgA-MM).Methods Sixty IgA-MM patients with double M bands admitted to the General Hospital of the Central Theater Command of the Chinese People's Liberation Army from January 2019 to January 2022 were selected as the study objects.The chromatographic data of serum protein electrophoresis and immunofixation electrophoresis(IFE)were compared.Serum with double M protein bands of IgA-MM was treated with 2-dimercaptoethanol(2-DE),and the double M protein bands were identified by IFE.Immunological test indexes of patients with two double M protein types were compared,including immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM),serum free light chain(sFLC)and Bene Jone protein(BJP).The conventional experimental indexes of patients with two types of double M protein were compared.The staging and efficacy of multiple myeloma in the international staging system(ISS)were compared between two IgA types of double-M proteinemic myeloma.Kaplan-Meier method and LOG-rank test were used to analyze the survival rate of patients with two types of double M protein.Results IFE showed that monoclonal light chain type and IgA polymeric type were two types of double M protein bands in IGA-MM serum.Monoclonal light chain patients had higher levels of sFLC(2970.14±876.82 mg/L vs 118.68±74.10 mg/L)and BJP(6.22±3.01 g/L vs 0.55±0.12 g/L)than the polymeric type patients(t=21.684,12.659,all P＜0.05).Compared with polymeric type patients,serum β2-MG(β2-microglobulin)(7.88±2.14 mg/L vs 4.65±1.56 mg/L),serum Ca(calcium)(2.64±0.24 mmol/L vs 2.32±0.20 mmol/L)and serum Creatinine(Scr)(182.85±64.23 μmol/L vs 90.52±42.20 μmol/L)of monoclonal light chain patients were increased(t=21.684,12.659,6.400,5.193,6.473),while the levels of Hb(Hemoglobin)(74.32±19.44 g/L vs 90.75±15.52 g/L)and Alb(albumin)(28.42±3.64 g/L vs 31.72±4.96 g/L)of monoclonal light chain patients were decreased(t=3.386,2.428),with significant differences(all P＜0.05).Compared with IgA polymerized type patients,monoclonal light chain type patients had higher ISS stage and lower curative effect(t=11.827,4.519,all P＜0.05).Survival analysis showed that the survival rate of IgA polymerized type was higher than that of monoclonal light chain type(x2=4.482,P＜0.05).Conclusion The two types of IgA-type double-M protein differed in efficacy and prognosis,so identifying the type of IgA-MM double M protein band may be particularly important.
immunofixation electrophoresisdouble M protein bandimmunoglobulin Amultiple myeloma
维普
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