Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays
Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays
复制标题
DOI：
10.4065/81.12.1575
复制
发表时间：
2006-12-01
影响因子：
8.9
通讯作者：
Rajkumar, S. Vincent
中科院分区：
文献类型：
--
作者：
Katzmann, Jerry A.;Dispenzieri, Angela;Rajkumar, S. Vincent
目的：为了确定尿分析的相对诊断贡献的一部分，单克隆gammopathyes.Patients和方法的筛选算法：我们确定了428例患者的单克隆gammopathy和单克隆尿蛋白在初步诊断浆细胞恶液质谁也经历了血清免疫固定和血清游离轻链定量在30天内诊断。血清蛋白电泳，血清免疫固定，血清游离轻链，尿蛋白电泳，尿免疫固定的实验室结果进行了review.RESULTS：患者的诊断多发性骨髓瘤，原发性淀粉样蛋白，单克隆丙种球蛋白病的意义不明，郁积型多发性骨髓瘤，孤立性浆细胞瘤，和其他不太常见的单克隆丙种球蛋白病。所有428例患者均存在单克隆尿蛋白，85.7%的血清游离轻链kappa/lambda比率异常，80.8%的血清蛋白电泳异常，93.5%的血清免疫固定结果异常。所有3项血清测定均正常，仅2例患者，其中1例患有意义不明的单克隆丙种球蛋白病（特发性Bence Jones蛋白尿）和I，其尿样含有完整的单克隆免疫球蛋白，但其血清和随后的尿样未显示单克隆丙种球蛋白病的证据。停止尿液检查并依赖仅使用血清检查的诊断算法（蛋白电泳、免疫固定和游离轻链定量）遗漏了428例尿单克隆蛋白单克隆丙种球蛋白病中的2例（0.5%），这2例不需要医疗干预。
OBJECTIVE: To determine the relative diagnostic contribution of urine assays as part of the screening algorithm for monoclonal gammopathies.PATIENTS AND METHODS: We identified 428 patients with a monoclonal gammopathy and monoclonal urinary protein at initial diagnosis of plasma cell dyscrasia who had also undergone serum immunofixation and serum free light chain quantitation within 30 days of diagnosis. The laboratory results for serum protein electron phoresis, serum immunofixation, serum free light chain, urine protein electrophoresis, and urine Immunofixation were reviewed.RESULTS: The patients had diagnoses of multiple myeloma, primary amyloid, monoclonal gammopathy of undetermined significance, smoldering multiple myeloma, solitary plasmacytomas, and other less frequently detected monoclonal gammopathies. All 428 had a monoclonal urine protein, 85.7% had an abnormal serum free light chain kappa/lambda ratio, 80.8% had an abnormal serum protein electrophoresis, and 93.5% had an abnormal serum immunofixation result. All 3 serum assays were normal In only 2 patients,.1 of whom had monoclonal gammopathy of undetermined significance (idiopathic Bence Jones proteinuria) and I whose urine sample contained an intact monoclonal immunoglobulin but whose serum and subsequent urine samples showed no evidence of a monoclonal gammopathy.CONCLUSION: Discontinuation of urine studies and reliance on a diagnostic algorithm using only serum studies (protein electrophoresis, immunofixation, and free light chain quantitation) missed 2 (0.5%) of the 428 monoclonal gammopathies with urinary monoclonal proteins, and these 2 cases required no medical Intervention.