文章：

多克隆血清游离轻链升高与单克隆丙种球蛋白病风险增加相关

Polyclonal serum free light chain elevation is associated with increased risk of monoclonal gammopathies

原文发布日期：2019-05-17

DOI: 10.1038/s41408-019-0210-z

类型: Article

开放获取: 是

英文摘要：

Monoclonal gammopathies (MG) constitute a spectrum of disorders starting from a monoclonal gammopathy of undetermined significance (MGUS) to active disease requiring therapy such as multiple myeloma. MG are characterized by proliferation of clonal plasma cells (PC) secreting a monoclonal protein either as intact immunoglobulin or free kappa or lambda free light chains (FLC). We hypothesized that a polyclonal elevation of serum FLC may indicate an inflammatory state that precedes development of MG. We studied 15,630 individuals from Olmsted county, who did not have MGUS based on baseline screening studies. At a median follow-up of 18.1 years, 264 patients had developed a clonal PC disorder; 252 with MGUS, 1 with SMM, 8 with MM, and 3 with amyloidosis, translating to an annual incidence of development of a MG of 0.1%. We examined the baseline polyclonal ΣFLC (kappa + lambda FLC) from the initial screening and grouped them into deciles. The highest decile group had a 2.6-fold (95% CI; 1.8, 3.7) increase in the risk of developing a MG, P < 0.001. We demonstrate for the first time, the increased risk of developing MG in patients with elevated serum FLC, suggesting that an underlying inflammatory state may play an etiologic role.
 

摘要翻译： 

单克隆丙种球蛋白病（MG）构成一系列疾病谱，从意义未明的单克隆丙种球蛋白病（MGUS）到需要治疗的活动性疾病，如多发性骨髓瘤。MG的特征是克隆性浆细胞增殖，分泌单克隆蛋白，可以是完整免疫球蛋白或游离κ或λ游离轻链（FLC）。我们假设，血清FLC的多克隆性升高可能预示一种炎症状态，该状态先于MG的发展。我们研究了来自奥姆斯特德县的15,630名个体，这些个体在基线筛查研究中未患有MGUS。在中位随访18.1年时，264名患者发展出克隆性浆细胞疾病；252例为MGUS，1例为SMM（冒烟型多发性骨髓瘤），8例为多发性骨髓瘤，3例为淀粉样变性，转化为MG的年发病率为0.1%。我们检查了初始筛查时的基线多克隆性ΣFLC（κ + λ FLC），并将其分组为十分位。最高十分位组的MG发生风险增加了2.6倍（95% CI；1.8, 3.7），P < 0.001。我们首次证明，血清FLC升高的患者发生MG的风险增加，表明潜在的炎症状态可能起病因作用。

原文链接：

Polyclonal serum free light chain elevation is associated with increased risk of monoclonal gammopathies