血脑屏障完整性及鞘内免疫球蛋白合成在中枢神经系统疾病中的意义

目的探讨中枢神经系统疾病血脑屏障(BBB)的完整性和鞘内免疫球蛋白合成的意义。方法将研究对象分为8组(A组为10例正常对照组,B组为10例化脓性脑膜炎患者,C组为10例结核性脑膜炎患者,D组为20例病毒性脑(膜)炎患者,E组为8例脱髓鞘疾病患者,F组为10例格林巴利综合症患者,G组为10例蛛网膜下腔出血和脑出血患者,H组为14例缺血性脑血管病患者),采用速率散射比浊方法测定血清和CSF的白蛋白(Alb)和免疫球蛋白(IgG、IgMI、gA)含量,利用公式计算QAlbI、gG指数、IgG合成率,并用Protis软件进行数据和图形处理分析。结果 (1)各组QAlb异常率均较正常对照组增高,其中B、C、E、G组QAlb明显高于正常对照组(P0.01);(2)B、C、E、G组IgG指数和IgG合成率较正常对照组明显增高(P0.05或0.01),其中IgG指数以E组最高,IgG合成率以B、E组最高;(3)经Protis软件分析82例患者,正常35例,单纯BBB功能障碍20例,仅有鞘内合成8例,BBB功能障碍伴有鞘内合成19例。结论通过对CSF中蛋白质组分定量的分析,并利用Protis软件进行数据和图形处理,可以明确中枢神经系统疾病血脑屏障完整性和鞘内免疫球蛋白的合成,以及对某些中枢神经系统疾病的诊断和鉴别诊断具有重要的临床意义。

The significance of blood-brain barrier integrality and intrathecal immunoglobulin synthesis in central nervous system disease

Objective To evaluate the significance of blood-brain barrier integrality and intrathecal immunogolbulin synthesis in central nervous system disease.Methods The studied subjects were divided into eight group（group A included 10 control cases,group B included 10 purulent meningitis patients,group C included 10 tuberculous meningitis patients,group D included 20 viral meningitis patients,group E included 8 multiple sclerosis patients,group F included 10 Guillain-Barre syndrome patients,group H included 14 cerebral infarction patients）,albumin、IgG、IgM、IgA in serum and CSF of these patients were synchronal detected by using rate nephelometry,QAlb,IgG index and IgG synthesis were calculated by formulas.The results were analyzed with Protis software system and the typical QAlb and Ig patterns were determined.Results（1）The levels of CSF albumin index in group B、C、E、G were obviously higher than those of control group（P0.01）.（2）The levels of IgG index and IgG synthesis in group B、C、E、G were obviously higher than those of control group,the level of IgG index in group E was tiptop.（3）The results were analyzed with Protis software system,35 patients were in normal range;20 patients had blood-brain barrier dysfunction;8 cases had intrathecal Ig synthesis without blood-brain barrier dysfunction;19 patients had both blood-brain barrier dysfunction and intrathecal Ig synthesis.Conclusions Both analyzed the ration of proteins in CSF and the result with Protis software system could definitude blood-brain barrier integrality and intrathecal immunoglobulin synthesis and had an important value to diagnosis and differential diagnosis in central nervous system disease.