背景:大量患有骨破坏的多发性骨髓瘤(MM)患者最初在医院接受骨科服务。然而,常规实验室检测通常无法识别这些患者,从而延迟最佳治疗。因此,在这些患者中,有明确的医学需要对MM进行早期诊断。
方法:在2019年至2021年之间,42例接受骨科疾病治疗的患者血红蛋白(Hb)正常,总蛋白(TP),白蛋白(ALB),肌酐(CREA),和血钙(Ca)水平在他们的手术前(S),但随后被病理证实患有MM,根据他们出现的骨科症状。在同一时期,52例有骨科疾病的患者在病理上被排除在MM的诊断之外,并被纳入我们的对照组。使用SiemensNLatexFLC试剂盒在骨科服务的94名连续患者中进行血清游离轻链(sFLC)测试。Hb的水平,TP,ALB,CREA,还测量了Ca。根据病理科将42例MM患者分为A组(n=25:κ增殖)和B组(n=17:λ增殖)。
结果:Hb水平无显著差异,TP,ALB,CREA,A组和B组和对照组之间的Ca。然而,A组和B组的sFLCκ/λ比值与对照组也有显著差异(P<.001)。血清免疫固定电泳(IFE)检测结果A组14例(58.3%),B组4例(25.0%),结果为阴性。
结论:部分骨科患者无典型MM实验室检查结果,比如那些血红蛋白异常的人,TP,ALB,CREA,以及手术前的Ca水平,其实有MM。对于无法解释的骨病变和sFLCκ/λ比值异常的患者,应高度怀疑MM。即使血清和尿液IFE结果为阴性且轻链比例正常,这些患者仍需要进一步的组织或骨髓活检。
BACKGROUND: A substantial number of patients with multiple myeloma (MM) who have bone destruction are initially admitted into the orthopedic service at the hospital. However, routine laboratory testing usually fails to identify these patients, thus delaying optimal therapy. Therefore, there is a clear medical need for early diagnosis of MM in these patients.
METHODS: Between 2019 and 2021, 42 patients receiving treatment for orthopedic conditions had normal hemoglobin (Hb), total protein (TP), albumin (ALB), creatinine (CREA), and blood calcium (Ca) levels before their surgical procedure(s) but were subsequently pathologically confirmed to have MM, based on their presenting orthopedic symptoms. During the same period, 52 patients with orthopedic conditions were pathologically excluded from the diagnosis of MM and were recruited into our control group. Serum free light chain (sFLC) testing was performed in 94 consecutive patients in the orthopedic service using Siemens N Latex FLC kits. The levels of Hb, TP, ALB, CREA, and Ca were also measured. All 42 patients with MM were divided into group A (n = 25: κ proliferation) and group B (n = 17: λ proliferation) by the pathology department.
RESULTS: There were no significant differences in levels of Hb, TP, ALB, CREA, and Ca between group A and group B and the control group. However, the sFLC κ/λ ratio of group A and B was also significantly different from that of the control group (P < .001). The results of serum immunofixation electrophoresis (IFE) testing demonstrated negative results in 14 cases (58.3%) in group A and 4 cases (25.0%) in group B.
CONCLUSIONS: Some patients with orthopedic conditions who do not have typical MM laboratory results, such as those with abnormal Hb, TP, ALB, CREA, and Ca levels before their operation(s), actually have MM. MM should be highly suspected in patients with unexplained bone lesions and with an abnormal sFLC κ/λ ratio. Further tissue or bone marrow biopsy is needed in these patients even if serum and urine IFE results are negative and light chain ratio is normal.