尿蛋白电泳在浆细胞疾病鉴别诊断中的价值

doi:10.3877/cma.j.issn.2095-655X.2024.04.001

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摘要许多浆细胞疾病会累及肾脏，导致肾脏功能不同程度受损，笔者将这部分疾病称为肾脏受累的浆细胞疾病（KiPCD）。如何鉴别这一类疾病，持续困扰着很多临床医生。虽然肾穿刺可以协助明确诊断，但其是有创操作，会大大增加患者的诊疗风险。因此临床更需要无创项目，来协助进行鉴别诊断。尿蛋白电泳（uPEP）是一项无创、简单的检查，也是浆细胞疾病诊疗中必不可少的检查。但很多临床医生只关注有无M蛋白以及M蛋白的量，而忽略了其在KiPCD诊断和鉴别诊断中的价值。本文将系统介绍uPEP，以及其在不同KiPCD中的特点，以进一步提高临床对KiPCD的鉴别能力，使更多的患者得到正确的诊断和治疗。

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关键词 ：尿蛋白电泳, 浆细胞疾病, 肾病, 多发性骨髓瘤, 轻链型淀粉样变性

Abstract：Many plasma cell diseases can affect the kidneys, leading to varing degrees of impairment in renal function. Such diseases in this paper will be referred to as kidney involved plasma cell diseases (KiPCD). How to distinguish these diseases continuously puzzled many physicians. Although kidney biopsy can provide a clear diagnosis most of the time, it is an invasive procedure that greatly increases the diagnosis and treatment risks for patients. So non-invasive testing is more needed in clinical practice to assist the differential diagnosis. Urinary protein electrophoresis (uPEP) is a non-invasive and simple examination. It is essential in the diagnosis and treatment of plasma cell diseases. Many physicians focus solely on the presence and amount of M protein while neglecting its value in the diagnosis and differential diagnosis of KiPCD. In order to further improve the clinical ability to distinguish KiPCD and let more patients receive optimal diagnosis and treatment, this article will systematically introduce uPEP and its distinct characteristics in different KiPCD.

Key words： Urinary protein electrophoresis Plasma cell disease Nephrosis Multiple myeloma Light chain amyloidosis

收稿日期: 2024-10-05

基金资助:国家自然科学基金地区科学基金项目（81660038）；广西壮族自治区卫生和计划生育委员会自筹经费科研课题（Z2016286）

通讯作者: 罗军， Email: luojungz@medmail.com.cn

引用本文:

李忠清罗军. 尿蛋白电泳在浆细胞疾病鉴别诊断中的价值[J]. 中华诊断学电子杂志, 2024, 12(4): 217-221.
Li Zhongqing, Luo Jun. . The differential diagnosis value of urinary protein electrophoresis in the plasma cell diseases. zhzdx, 2024, 12(4): 217-221.

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［1］Leypoldt LB,Gavriatopoulou M,Besemer B,et al.Daratumumab,bortezomib,and dexamethasone for treatment of patients with relapsed or refractory multiple myeloma and severe renal impairment：results from the phase 2 GMMG-DANTE trial［J］.Cancers(Basel),2023,15(18)：4667.DOI：10.3390/cancers15184667. ［2］中华医学会血液学分会,中国抗癌协会血液肿瘤专业委员会,中国少见浆细胞病协作组.有临床意义的单克隆免疫球蛋白血症的诊断及鉴别诊断中国专家共识（2022年版）［J］.中华血液学杂志,2022,43(8):631-635.DOI：10.3760/cma.j.issn.0253-2727.2022.08.003. ［3］Yan W,Cao Y,Liao A,et al.A prognostic staging system for light-chain amyloidosis using hepatic and renal indicator data from 1,064 Chinese patients［J］.Ann Transl Med,2021,9(16):1347.DOI：10.21037/atm-21-4033. ［4］Kumar S, Paiva B, Anderson KC,et al.International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma［J］.Lancet Oncol,2016,17(8):e328-e346.DOI：10.1016/S1470-2045(16)30206-6. ［5］万学红，卢学峰，刘成玉，等.诊断学［M］.9版.北京：人民卫生出版社,2018：353-354. ［6］中国医师协会血液科医师分会,中华医学会血液学分会.中国多发性骨髓瘤诊治指南（2022年修订）［J］.中华内科杂志，2022,61(5):480-487.DOI:10.3760/cma.j.cn112138-20220309-00165. ［7］Rajkumar SV.Multiple myeloma：2022 update on diagnosis,risk stratification,and management［J］.Am J Hematol,2022,97(8):1086-1107.DOI：10.1002/ajh.26590. ［8］中国医师协会血液科医师分会,中国老年医学学会血液学分会,中国研究型医院学会肾脏病学专委会.多发性骨髓瘤肾损伤诊治指南（2024版）［J］.中华内科杂志,2024,63(4):343-354.DOI：10.3760/cma.j.cn112138-20240111-00027. ［9］Dimopoulos MA,Merlini G,Bridoux F,et al.Management of multiple myeloma-related renal impairment：recommendations from the International Myeloma Working Group［J］.Lancet Oncol,2023,24(7):e293-e311.DOI：10.1016/S1470-2045(23)00223-1. ［10］Kundu S,Jha SB,Rivera AP,et al.Multiple myeloma and renal failure：mechanisms,diagnosis,and management［J］.Cureus,2022,14(2):e22585.DOI：10.7759/cureus.22585. ［11］Doshi M,Lahoti A,Danesh FR,et al.Paraprotein-related kidney disease：kidney injury from paraproteins-what determines the site of injury?［J］.Clin J Am Soc Nephrol,2016,11(12):2288-2294.DOI：10.2215/CJN.02560316. ［12］中国系统性轻链型淀粉样变性协作组,国家肾脏疾病临床医学研究中心,国家血液系统疾病临床医学研究中心.系统性轻链型淀粉样变性诊断和治疗指南（2021年修订）［J］.中华医学杂志,2021,101(22):1646-1656.DOI：10.3760/cma.j.cn112137-20210302-00534. ［13］Sanchorawala V.Systemic light chain amyloidosis［J］.N Engl J Med，2024,390(24):2295-2307.DOI：10.1056/NEJMra2304088. ［14］Wechalekar AD, Schonland SO, Kastritis E, et al. A European collaborative study of treatment outcomes in 346 patients with cardiac stage Ⅲ AL amyloidosis［J］.Blood,2013,121(17):3420-3427.DOI：10.1182/blood-2012-12-473066. ［15］Landau H, Hassoun H, Rosenzweig MA, et al. Bortezomib and dexamethasone consolidation following risk-adapted melphalan and stem cell transplantation for patients with newly diagnosed light-chain amyloidosis［J］.Leukemia,2013,27(4):823-828.DOI：10.1038/leu.2012.274. ［16］Gertz MA,Comenzo R,Falk RH,et al.Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL)：a consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis,Tours,France,18-22 April 2004［J］.Am J Hematol,2005,79(4):319-328.DOI：10.1002/ajh.20381. ［17］Hussain M,Yellapragada S,Al Hadidi S.Differential diagnosis and therapeutic advances in multiple myeloma：a review article［J］.Blood Lymphat Cancer,2023(13):33-57.DOI：10.2147/BLCTT.S272703. ［18］Tovar N, Rodríguez-Lobato LG, Cibeira MT,et al.Bone marrow plasma cell infiltration in light chain amyloidosis：impact on organ involvement and outcome［J］.Amyloid,2018,25(2):79-85.DOI：10.1080/13506129.2018.1443439. ［19］Wang Q,Jiang F,Xu G.The pathogenesis of renal injury and treatment in light chain deposition disease［J］.J Transl Med,2019,17(1):387.DOI：10.1186/s12967-019-02147-4. ［20］王季诺,冯俊,曹欣欣,等.11例原发性轻链沉积病患者的临床特征分析［J］.中华血液学杂志,2017,38(3):253-256.DOI：10.3760/cma.j.issn.0253-2727.2017.03.017. ［21］Leung N,Bridoux F,Nasr SH.Monoclonal gammopathy of renal significance［J］.N Engl J Med,2021,384(20):1931-1941.DOI:10.1056/NEJMra1810907.