肾功能指标联合检测对多发性骨髓瘤肾功能不全诊断价值的分析
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摘要
目的探讨肾功能指标联合检测对多发性骨髓瘤(MM)肾功能不全的诊断价值。方法对192例明确诊断的MM患者的肾功能检测指标[肌酐(SCr)、24小时尿蛋白(24hPro)、尿素氮(BUN)、血尿酸(UA)、白蛋白(ALB)、血β2微球蛋白(β2-MG)、尿kappa轻链(uKAP)、尿lambda轻链(uLAM)]进行分析。比较血清SCr+轻链蛋白尿+24hPro联合诊断和SCr单项诊断MM患者肾功能不全的检出率,以及经SCr+轻链蛋白尿+24hPro诊断为肾功能不全后,不同国际分期体系(ISS)分期的MM患者肾功能相关指标水平,并通过各检测指标的受试者工作特征曲线(简称ROC曲线)下面积评估其对MM肾功能不全的诊断价值。结果 SCr+轻链蛋白尿+24hPro诊断肾功能不全的检出率为38.0%,明显高于单独SCr诊断的18.2%(P﹤0.01);不同ISS分期患者的年龄及ALB、β2-MG、24hPro、uKAP、u LAM、UA、BUN、SCr水平比较,差异均有统计学意义(P﹤0.05);根据各检测指标的ROC曲线下面积,24hPro诊断肾功能不全的价值最高,其次分别为SCr、BUN、β2-MG、uKAP、UA及uLAM(P﹤0.05)。结论在判断MM患者肾功能不全时,除检测BUN和SCr外,还应结合24hPro、uKAP、uLAM、UA、β2-MG等指标进行综合判断,以便对MM患者的肾功能状态做出准确的评估。
Objective To investigate the diagnostic value of combined detection of renal function biomarkers in multiple myeloma(MM) with renal insufficiency. Method A analysis was performed for 192 patients with clinically confirmed MM to detect their renal function biomarkers [serum creatinine(SCr), 24-hour urine protein(24 hPro), blood urea nitrogen(BUN), blood uric acid(UA), albumin(ALB), blood β2 microglobulin(β2-MG), urine kappa light chain(uKAP), urine lambda light chain(uLAM)]. The detection rate of renal insufficiency in MM patients using combined detection of SCr + light chains proteinuria + 24 hPro and SCr alone was compared, besides, after the diagnosis of renal insufficiency by SCr + light chain proteinuria+ 24 hPro, the renal function biomarker levels among MM patients classified using varying international stating system(ISS) were determined, and the receiver operating characteristic curve(ROC) of each marker was detected to assess the diagnostic value for renal insufficiency in MM patients. Result The combined detection of SCr + light chain proteinuria + 24 h Pro had a detection rate of 38.0%, which was significantly higher than that of SCr alone at 18.2%(P<0.01); among patients with different ISS stage, there were significant differences regarding age,ALB, β2-MG, 24 hPro, uKAP, uLAM, UA, BUN, and SCr, and there was statistical significance noted(P<0.05). According to the area under ROC curve, 24 hPro showed the highest diagnostic value for diagnosing renal insufficiency, followed by SCr, BUN, β2-MG, uKAP, UA and u LAM(P<0.05). Conclusion When diagnosing renal insufficiency in MM patients, in addition to BUN and SCr, 24 hPro, uKAP, uLAM, UA, and β2-MG should also be comprehensively considered,so as to make an accurate assessment of the renal function of MM patients.
Objective To investigate the diagnostic value of combined detection of renal function biomarkers in multiple myeloma(MM) with renal insufficiency. Method A analysis was performed for 192 patients with clinically confirmed MM to detect their renal function biomarkers [serum creatinine(SCr), 24-hour urine protein(24 hPro), blood urea nitrogen(BUN), blood uric acid(UA), albumin(ALB), blood β2 microglobulin(β2-MG), urine kappa light chain(uKAP), urine lambda light chain(uLAM)]. The detection rate of renal insufficiency in MM patients using combined detection of SCr + light chains proteinuria + 24 hPro and SCr alone was compared, besides, after the diagnosis of renal insufficiency by SCr + light chain proteinuria+ 24 hPro, the renal function biomarker levels among MM patients classified using varying international stating system(ISS) were determined, and the receiver operating characteristic curve(ROC) of each marker was detected to assess the diagnostic value for renal insufficiency in MM patients. Result The combined detection of SCr + light chain proteinuria + 24 h Pro had a detection rate of 38.0%, which was significantly higher than that of SCr alone at 18.2%(P<0.01); among patients with different ISS stage, there were significant differences regarding age,ALB, β2-MG, 24 hPro, uKAP, uLAM, UA, BUN, and SCr, and there was statistical significance noted(P<0.05). According to the area under ROC curve, 24 hPro showed the highest diagnostic value for diagnosing renal insufficiency, followed by SCr, BUN, β2-MG, uKAP, UA and u LAM(P<0.05). Conclusion When diagnosing renal insufficiency in MM patients, in addition to BUN and SCr, 24 hPro, uKAP, uLAM, UA, and β2-MG should also be comprehensively considered,so as to make an accurate assessment of the renal function of MM patients.
引文
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[4]中国医师协会血液科医师分会,中华医学会血液学分会,中国医师协会多发性骨髓瘤专业委员会.中国多发性骨髓瘤诊治指南(2013年修订)[J].中华内科杂志,2013,52(9):791-795.
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[8]Corso A,Zappasodi P,Pascutto C,et al.Urinary proteins inmultiple myeloma:correlation with clinical parameters anddiagnostic implications[J].Ann Hematol,2003,82(8):487-491.
[9]钟赟,袁振刚,傅卫军,等.多发性骨髓瘤肾损害早期评估的探讨[J].中华血液学杂志,2012,33(10):819-822.
[10]刘诗静,翟勇平,于亚平,等.低分子尿蛋白在评估多发性骨髓瘤早期肾损害中的作用[J].中国实验血液学杂志,2013,21(2):410-414.
[11]Du W,Shen T,Li H,et al.Urinary NGAL for the diagnosis of the renal injury frommultiple myeloma[J].Cancer Biomark,2017,18(1):41-46.
[2]Tia Weu M,Guei Monlet C,Sawadogo A,et al.Renal involvement during monoclonal gammopathies at the teaching hospital of Yopougon in Abidjan,from 2000 to 2016[J].Mali Med,2018,33(1):6-9.
[3]多发性骨髓瘤肾损伤诊治专家共识协作组.多发性骨髓瘤肾损伤诊治专家共识[J].中华内科杂志,2017,56(11):871-875.
[4]中国医师协会血液科医师分会,中华医学会血液学分会,中国医师协会多发性骨髓瘤专业委员会.中国多发性骨髓瘤诊治指南(2013年修订)[J].中华内科杂志,2013,52(9):791-795.
[5]Greipp PR,San Miguel J,Durie B,et al.International staging system for multiple myeloma[J].J Clin Oncol,2005,23(15):3412-3420.
[6]Dimopoulos M,Siegel D,White DJ,et al.Carfilzomib vs bortezomib in patients with multiple myeloma and renal failure:a subgroup analysis of ENDEAVOR[J].Blood,2019,133(2):147-155.
[7]Corso A,Serricchio G,Zappasodi P,et al.Assessment of renalfunction in patients with multiple myeloma:the role of urinaryproteins[J].Ann Hematol,1999,78(8):371-375.
[8]Corso A,Zappasodi P,Pascutto C,et al.Urinary proteins inmultiple myeloma:correlation with clinical parameters anddiagnostic implications[J].Ann Hematol,2003,82(8):487-491.
[9]钟赟,袁振刚,傅卫军,等.多发性骨髓瘤肾损害早期评估的探讨[J].中华血液学杂志,2012,33(10):819-822.
[10]刘诗静,翟勇平,于亚平,等.低分子尿蛋白在评估多发性骨髓瘤早期肾损害中的作用[J].中国实验血液学杂志,2013,21(2):410-414.
[11]Du W,Shen T,Li H,et al.Urinary NGAL for the diagnosis of the renal injury frommultiple myeloma[J].Cancer Biomark,2017,18(1):41-46.