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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 a reference range of serum free light chain ratio (sFLC-R) in healthy subjects in Shanghai and investigate the clinical value of sFLC-R in the diagnosis of plasma cell neoplasm (PCN). Methods: From December 2014 to February 2015, 65 healthy volunteers in Zhongshan Hospital Affiliated to Fudan University were enrolled as healthy group, 29 as nephropathy group as nephropathy group and 27 as PCN group as PCN group. The concentrations of serum kappa and lambda free light chains were measured to calculate sFLC-R. Results: The sFLC-R of healthy population obtained the reference range of 0.54-1.15 from the 2.5 and 97.5 percentiles on both sides. The concentration of kappa and lambda free light chain in nephropathy group was higher than that in healthy group (P <0.05), and the difference between abnormal rate and PCN group was small. However, the abnormal rate of sFLC-R was significantly different from PCN group. PCF group sFLC-R mainly distributed outside the reference range, and to λ free light chain increased mainly. CONCLUSIONS: sFLC reflects the dynamic process of plasma cell production and renal excretion, and its absolute value may increase upon abnormal proliferation of plasma cells or a decrease in glomerular filtration rate, but sFLC-R is limited only by immunoglobulins or light chains Sexual expression increased or decreased, no change in glomerular filtration rate decreased, can be used for early diagnosis and differential diagnosis of PCN.