摘要
目的:建立上海地区健康人群血清游离轻链比值(serum free light chain ratio,sFLC-R)参考范围,并探讨sFLC-R对浆细胞肿瘤(plasma cell neoplasm,PCN)患者的临床诊断价值。方法:纳入2014年12月至2015年2月复旦大学附属中山医院健康体检者65例为健康组,肾脏病患者29例为肾病组,PCN患者27例为PCN组。检测研究对象血清κ和λ游离轻链浓度,计算sFLC-R。结果:健康人群sFLC-R取双侧2.5和97.5百分位点得出参考范围为0.54~1.15。肾病组患者κ和λ游离轻链浓度高于健康组(P<0.05),异常率与PCN组差异较小,但sFLC-R异常率与PCN组差异较大。PCN组sFLC-R主要分布于参考范围外,且以λ游离轻链水平增高为主。结论:sFLC反映了浆细胞生成和肾脏排泄的动态过程,其绝对值在浆细胞异常增殖或肾小球滤过率下降时均可升高,但sFLC-R仅在免疫球蛋白或轻链限制性表达时出现升高或降低,在肾小球滤过率降低时无变化,可用于PCN的早期诊断和鉴别诊断。
Objective：To establish the reference ranges of serum free light chain ratio （sFLC-R） in Shanghai, and to study the preliminary clinical significance of sFLC-R for plasma cell neoplasm（PCN）diagnosis.Methods：Sixty-five healthy individuals undergoing ordinary health examinations in Zhongshan Hospital, Fudan University were recruited as the healthy group;29 patients with kidney disease as the kidney disease group;27 patients with PCN as the PCN group.All participants enrolled received the serum-free kappa and lambda light chain detection, and sFLC-R was calculated for further analysis.Results：The reference range of serum free light chain ratio was 0.54-1.15 （97.5% conference interval）.The concentrations of κ and λ FLC in kidney disease group were higher than those in healthy group （P〈0.05）.The abnormalities ratios of sFLC had a slight difference from that of the disease group, but the difference of the sFLC-R abnormalities ratios was quite apparent.The majority sFLC-Rs in PCN group were outside the reference range, especially the increase of λ FLC.Conclusions：The concentration of serum-free light chain could reflect the dynamic process of plasma cell production and renal excretion, and sFLC could increase in either plasma cell proliferation or decreased glomerular filtration situations.However, sFLC-R only showed significant changes under the situations in which expressions of either immunoglobulin or light chain were restricted, but remained normal when glomerular filtration decreased.Therefore, the detection of sFLC-R could be a promising tool for early diagnosis and differential diagnosis of plasma cell diseases.
出处
《中国临床医学》
2017年第3期348-352,共5页
Chinese Journal of Clinical Medicine
基金
国家自然科学基金(81572064)
上海市卫生计生系统重要薄弱学科建设项目(2015ZB0201)~~
关键词
血清游离轻链
血清游离轻链比值
浆细胞肿瘤
参考范围
free light chain （FLC）
free light chain ratio （FLC-R）
plasma cell neoplasm （PCN）
reference ranges
