PDF(Pubmed)
Abstract：
UNASSIGNED: Both primary (e.g. common variable immune deficiency, CVID) and secondary immune deficiency as well as multiple myeloma (MM) require medical intervention and treatment delay can exacerbate morbidity. This study investigated the potential importance of low levels of calculated globulin to detect immune deficiency and MM associated with immunoparesis (light chain, non-secretory MM).
UNASSIGNED: One hundred and thirty-nine patient serum samples from community physicians and outpatient clinics for liver function tests with low calculated globulin (<16 g/L, RR 18-37 g/L) levels were screened for immunoglobulins and protein electrophoresis. Further, 110 patients with globulin levels ≤16 g/L with screening for immunoglobulin levels and protein electrophoresis, requested through routine clinical care, were included in the analysis.
UNASSIGNED: Approximately 47% of patients in this cohort had secondary antibody deficiency as a result of hematological malignancy. Secondary iatrogenic (immunosuppressants, antiepileptic drugs) immune deficiency was detected in 20% of patients and a significant percentage of the patients were found by reflex testing at globulin levels <16 g/L. During the study period the screening detected new light chain and non-secretory MM in 2.2% of patients. Three patients with CVID and six patients with light chain myeloma were previously detected by screening, consequently alerting clinicians and reducing delay in treatment. A further 23% with several co-morbid conditions showed unexpected hypogammaglobulinemia; in this category, the study identified a subgroup that required further investigation.
UNASSIGNED: Investigation of low globulin levels detects patients with primary and secondary immune deficiency and MM. Optimizing treatment for decreased immunoglobulins in patients with other clinical co-morbidities may require increased clinician awareness and watchful clinical and laboratory assessment.
UNASSIGNED: One hundred and thirty-nine patient serum samples from community physicians and outpatient clinics for liver function tests with low calculated globulin (<16 g/L, RR 18-37 g/L) levels were screened for immunoglobulins and protein electrophoresis. Further, 110 patients with globulin levels ≤16 g/L with screening for immunoglobulin levels and protein electrophoresis, requested through routine clinical care, were included in the analysis.
UNASSIGNED: Approximately 47% of patients in this cohort had secondary antibody deficiency as a result of hematological malignancy. Secondary iatrogenic (immunosuppressants, antiepileptic drugs) immune deficiency was detected in 20% of patients and a significant percentage of the patients were found by reflex testing at globulin levels <16 g/L. During the study period the screening detected new light chain and non-secretory MM in 2.2% of patients. Three patients with CVID and six patients with light chain myeloma were previously detected by screening, consequently alerting clinicians and reducing delay in treatment. A further 23% with several co-morbid conditions showed unexpected hypogammaglobulinemia; in this category, the study identified a subgroup that required further investigation.
UNASSIGNED: Investigation of low globulin levels detects patients with primary and secondary immune deficiency and MM. Optimizing treatment for decreased immunoglobulins in patients with other clinical co-morbidities may require increased clinician awareness and watchful clinical and laboratory assessment.
摘要：
■两者都是原发性的(例如常见的可变免疫缺陷，CVID）和继发性免疫缺陷以及多发性骨髓瘤（MM）需要医学干预，治疗延迟会加剧发病率。本研究调查了低水平的计算球蛋白对检测免疫缺陷和与免疫轻瘫相关的MM（轻链，非分泌型MM)。
■来自社区医生和门诊部的139例患者血清样本，用于低计算球蛋白的肝功能测试（<16g/L，RR18-37g/L）水平进行免疫球蛋白和蛋白质电泳筛选。Further,110例球蛋白水平≤16g/L的患者，进行免疫球蛋白水平和蛋白电泳筛查，通过常规临床护理要求，包括在分析中。
■该队列中大约47%的患者由于血液系统恶性肿瘤而出现二次抗体缺乏。继发性医源性（免疫抑制剂，抗癫痫药）在20％的患者中检测到免疫缺陷，并且通过在球蛋白水平<16g/L的反射测试发现了很大一部分患者。在研究期间，筛查在2.2％的患者中检测到新的轻链和非分泌性MM。先前通过筛查检测到3例CVID患者和6例轻链骨髓瘤患者，因此提醒临床医生和减少延误治疗。另外有23％的人患有几种合并症，表现出意外的低丙种球蛋白血症；在这一类中，该研究确定了一个需要进一步调查的亚组.
■低球蛋白水平的调查可检测原发性和继发性免疫缺陷和MM的患者。在患有其他临床合并症的患者中，优化免疫球蛋白减少的治疗可能需要提高临床医生的意识以及观察临床和实验室评估。
■来自社区医生和门诊部的139例患者血清样本，用于低计算球蛋白的肝功能测试（<16g/L，RR18-37g/L）水平进行免疫球蛋白和蛋白质电泳筛选。Further,110例球蛋白水平≤16g/L的患者，进行免疫球蛋白水平和蛋白电泳筛查，通过常规临床护理要求，包括在分析中。
■该队列中大约47%的患者由于血液系统恶性肿瘤而出现二次抗体缺乏。继发性医源性（免疫抑制剂，抗癫痫药）在20％的患者中检测到免疫缺陷，并且通过在球蛋白水平<16g/L的反射测试发现了很大一部分患者。在研究期间，筛查在2.2％的患者中检测到新的轻链和非分泌性MM。先前通过筛查检测到3例CVID患者和6例轻链骨髓瘤患者，因此提醒临床医生和减少延误治疗。另外有23％的人患有几种合并症，表现出意外的低丙种球蛋白血症；在这一类中，该研究确定了一个需要进一步调查的亚组.
■低球蛋白水平的调查可检测原发性和继发性免疫缺陷和MM的患者。在患有其他临床合并症的患者中，优化免疫球蛋白减少的治疗可能需要提高临床医生的意识以及观察临床和实验室评估。
