중경쇄 정량검사의 유효성 검토
Evaluation of the Effectiveness of the Heavy-Light Chain Quantitative Test
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
배경: 중경쇄 정량검사는 단세포군 면역글로불린의 중쇄 및 경쇄의 유형을 개별적으로 확인하고, 정량적으로 중경쇄의 농도를 측정하는 검사이다. 본 연구에서는 중경쇄 정량검사의 임상적 유효성을 평가하였다. 방법: 중경쇄 정량검사의 유효성은 체계적 문헌고찰방법을 이용하였으며, 국내문헌은 KoreaMed를 포함한 8개 데이터베이스와 국외문헌은 Ovid-MEDLINE, Ovid-EMBASE, Cochran Library에서 2013년 10월 10일 최종 검색을 완료하였다. 코호트 연구 5편, 진단법 평가연구 1편의 연구를 최종 평가에 포함하였으며 문헌의 질 평가는 The Scottish Intercollegiate Guidelines Network (SIGN) 도구를 이용하였고, 자료추출에서 각 단계는 2명의 평가자가 독립적으로 수행하였다. 결과: 기존 검사들과의 상관성은 단클론 IgA가 증가한 환자를 대상으로 한 1편의 문헌에서 중경쇄 정량검사는 비교대상인 기존 검사들과 상관계수 0.94의 유의한 상관관계를 보였고, 예후 예측에서의 유효성은 HLCR에 따른 생존율을 분석한 5편의 문헌에서 중경쇄 정량검사 결과 HLCR이 높을수록 생존율이 유의하게 낮았고, IgAκ/λ 비, IgMκ/λ 비 증가는 무진행 생존율 증가와 통계적으로 유의한 연관성이 보고되었다. 결론: 중경쇄 정량검사는 단세포군 감마글로불린병증 소견이 있는 환자에서 중경쇄의 농도를 정량적으로 확인할 수 있으며, 유형 분석, 예후 예측하는 데 있어 유효성의 근거가 있는 검사로 평가되었다.
Abstract
Background: The heavy-light chain (HLC) quantitative test can identify and quantify the heavy and light chains of each immunoglobulin class. The purpose of this study was to evaluate the effectiveness of the HLC quantitative test. Methods: To evaluate the effectiveness of the HLC quantitative test, a systemic review of the literature, using Ovid-MEDLINE, EMBASE, Cochrane library, and eight domestic databases including KoreaMed, was performed until October 10, 2013. We included five cohort studies and one diagnostic evaluation study in the final evaluation. Two reviewers independently assessed the quality of the included studies and extracted data from the studies. The quality of the studies was assessed according to the Scottish Intercollegiate Guidelines Network (SIGN) tool. Results: A correlation between the HLC quantitative test and previous assays was evaluated in one study, which enrolled patients with increased monoclonal IgA. The correlation coefficient was reported as 0.94 in this study. The clinical significance of the quantitative HLC test to predict a prognosis was also reported in five cohort studies. The survival rate in patients with higher HLC ratio was significantly lower and the increased IgA κ/λ ratio or IgM κ/λ ratio was significantly correlated with higher survival rate in patients with monoclonal gammaglobulinemia. Conclusions: The HLC quantitative test is an effective test that can quantitatively measure the identified immunoglobulin type and predict the prognosis of patients with monoclonal gammopathy.
참고문헌 (15)
- 황유선, "형질세포종양의 진단에서 선별검사들의 유용성 검토", Laboratory Medicine Online, 2(2), pp.80~86 (2012), 대한진단검사의학회
- 정선경, "다발성골수종 환자의 진단 및 치료효과 추적을 위한 혈청 유리형 경쇄 정량검사의 의의", Annals of Laboratory Medicine, 28(3), pp.169~173 (2008), 대한진단검사의학회
- Bradwell AR, "Highly sensitive, automated immunoassay for immunoglobulin free light chains in serum and urine", Clin Chem, 47, pp.673~680 (2001)
- Durie BG, "International uniform response criteria for multiple myeloma", Leukemia, 20, pp.1467~1473 (2006)
- Bradwell AR, "Assessment of monoclonal gammopathies by nephelometric measurement of individual immunoglobulin kappa", lambda ratios, 2009, pp.55, 1646~1655
- "SIGN 50: a guideline developer’s handbook"[URL]
- Wolff F, "Assessment of the diagnostic performances of IgA heavy and light chain pairs in patients with IgA monoclonal gammopathy", Clin Biochem, 46, pp.79~84 (2013)
- Bradwell A, "Prognostic utility of intact immunoglobulin Ig’κ", Ig’λ ratios in multiple myeloma patients, 2013, pp.27, 202~207
- Ludwig H, "Immunoglobulin heavy", light chain ratios improve paraprotein detection and monitoring, identify residual disease and correlate with survival in multiple myeloma patients, 2013, pp.27, 213~219
- Katzmann JA, "Suppression of uninvolved immunoglobulins defined by heavy", light chain pair suppression is a risk factor for progression of MGUS, 2013, pp.27, 208~212
- Koulieris E, "Ratio of involved", uninvolved immunoglobulin quantification by HevyliteTMassay: clinical and prognostic impact in multiple myeloma, 2012, pp.1, 9~
- Tovar N, "Prognostic impact of serum immunoglobulin heavy", light chain ratio in patients with multiple myeloma in complete remission after autologous stem cell transplantation, 2012, pp.18, 1076~1079
- McPherson RA, "Henry’s clinical diagnosis and management by laboratory methods", pp.835~848 (2007), WB Saunders
- "Guidelines for the diagnosis and management of multiple myeloma 2013"[URL]
- Kraj M, "Comparison of immunoglobulin free light chain (FLC), heavy chain", light chain (HLC) assays and immunofixation (IFE) in assessment of remission in multiple myeloma, 2012, pp.43, 122~131