血清免疫固定电泳在骨髓瘤肾脏病患者诊断中的意义

目的　评价血清免疫球蛋白定量、血清蛋白电泳和血清免疫固定电泳在骨髓瘤肾病诊断和鉴别诊断中的敏感性和准确性。方法　对 4 1份骨髓瘤肾病和 36份其他肾功能损害患者的血清标本 ,采用血清免疫球蛋白定量、血清蛋白电泳和血清免疫固定电泳同时进行检测 ,求其单克隆免疫球蛋白的检出率 ,并将结果用SPSS10 0统计软件进行分析 ,以此来评价方法的敏感性和准确性。结果　免疫球蛋白定量不能检出单克隆成分 ;血清蛋白电泳对IgG和IgM型骨髓瘤检出率达 10 0 % ,其他型有较大缺陷 ,准确性及假阳性率无法判定。除不分泌型骨髓瘤外 ,免疫固定电泳对表现为肾功能损害的各型骨髓瘤检出率达 10 0 % ,准确性 10 0 % ,对照组无一假阳性。对照组与骨髓瘤肾病组比较差异有显著意义 (P <0 0 1)。 3种方法进行两两比较 ,相互间差异均有显著意义 (P <0 0 1)。结论血清免疫固定电泳较血清蛋白电泳和血清免疫球蛋白定量 ,在诊断和鉴别诊断骨髓瘤肾损害中有较高的敏感性和准确性 ,应作为肾脏疾病的常规检查项目在临床使用。

Use of serum immunofixation electrophoresis for the diagnosis of renal diseases

Objective To evaluate the accuracy and sensitivity of three techniques in the diagnosis of renal diseases following multiple myeloma. Methods 41 serum samples from the kidney-damaged patients with multiple myeloma and 36 from the control group with general renal diseases were detected by quantitative analysis of immunoglobulins, serum protein electrophoresis and serum Immunofixation Electrophoresis. The accuracy and sensitivity of the three techniques were analysed by Two-way ANOVA and Multiple Comparisons of the check-out rate of monoclonal immunoglobulin. Results No monoclonal components were checked out by quantitative analysis of immunoglobulins. The checkout rate of IgG and IgM myelomas were 100% by serum protein electrophoresis, which had application limit on other types of myelomas. Whereas all secretarial myelomas could be diagnosed and typied by Immunofixation Electrophoresis, the sensitivity and accuracy was 100%, there was no false positive in the control group. Comparing with quantitative analysis of immunoglobulins and serum protein electrophoresis, serum Immunofixation electrophoresis had higher sensitivity and accuracy in diagnosis of renal diseases following multiple myeloma ( P <0.01). Conclusion Serum immunofixation electrophoresis could be used for the diagnosis of renal diseases.