异常游离轻链(FLC)测试的临床意义,在没有已知的浆细胞发育不良(PCD)或淋巴增生性疾病(LPD)的情况下,由于非特异性抱怨而进行,还没有完全阐明。我们调查了在这种情况下异常FLC比率(FLC-R)的重要性。在马卡比医疗服务数据库中注册的患者,在2007-2023年期间对FLC进行了测试,没有先前记录的PCD/LPD或总蛋白(TP)水平增加,被审查了。人口统计,合并症,并记录了实验室测试。FLC-R定义为正常(0.26-1.65)或轻微(slAb0.1-0.26/1.65-4),中度(mAbn0.1-0.05/4-8)和显着异常(sigAb-<0.05或>8)。确定了与PCD/LPD和总生存期相关的因素。总的来说,8,661名患者,2,215(25.6%)FLC-R异常[2,090(24.1%)-slAb,65(0.75%)-mAbn和60(0.7%)-sigAb],进行了分析。几乎没有人患有贫血或急性肾功能衰竭。14%的人伴随免疫球蛋白增加。在52个月的中位随访时间内,943例诊断为PCD(816-MGUS,127-MM/淀粉样变/浆细胞瘤)和48具有LPD。PCD和LPD的中位时间分别为19和28个月。多因素分析发现slAb(HR=1.8,CI95%:1.53-2.12,p<0.001),mAbn(HR=6.3,CI95%:4.16-9.53,p<0.001),和sigAbFLC(HR=10.4,CI95%:7.0-15.35,p<0.001),与PCD/LPD诊断相关。IgG减少,IgA升高,伴随的合并症预测PCD,而IgM升高预测LPD。年纪大了,男性,贫血,白蛋白减少,IgG增加和伴随的合并症,预测生存期较短。我们的大型研究强调,即使在TP水平正常的患者中,异常FLC-R作为PCD/LPD诊断的预测因子也具有独立的临床意义。促进PCD/LPD的早期检测。
The clinical significance of an abnormal free light chain (FLC) test, performed due to unspecific complains in the absence of a known plasma cell dyscrasia (PCD) or lymphoproliferative disease (LPD), is not fully elucidated. We investigated the importance of an abnormal FLC ratio (FLC-R) in this setting. Patients registered in the Maccabi Healthcare Services database, tested for FLC during 2007-2023 without previously documented PCD/LPD or increased total protein (TP) level, were reviewed. Demographics, co-morbidities, and laboratory tests were recorded. FLC-R was defined as normal (0.26-1.65) or slightly (slAb 0.1-0.26/1.65-4), moderately (mAbn 0.1-0.05/4-8) and significantly abnormal (sigAb- < 0.05 or > 8). Factors associated with PCD/LPD and overall survival were identified. In total, 8,661 patients, 2,215 (25.6%) with abnormal FLC-R [2,090 (24.1%)-slAb, 65 (0.75%)-mAbn and 60 (0.7%)-sigAb], were analyzed. Almost none had anemia nor acute renal failure. 14% had concomitant increased immunoglobulins. Within a median follow-up of 52 months, 943 were diagnosed with PCD (816-MGUS, 127-MM/Amyloidosis/plasmacytoma) and 48 with LPD. Median time to PCD and LPD were 19 and 28 months. Multivariate analysis found slAb (HR = 1.8, CI95%:1.53-2.12, p < 0.001), mAbn (HR = 6.3, CI95%:4.16-9.53, p < 0.001), and sigAb FLC (HR = 10.4, CI95%:7.0-15.35, p < 0.001), to be associated with PCD/LPD diagnosis. Decreased IgG, increased IgA, and concomitant comorbidities predicted PCD, whereas increased IgM predicted LPD. Older age, male gender, anemia, decreased albumin, increased IgG and concomitant comorbidities, predicted shorter survival. Our large study emphasizes the independent clinical significance of abnormal FLC-R as a predictor of PCD/LPD diagnosis even in patients with normal TP level, promoting early detection of PCD/LPD.