寡克隆带和IgG鞘内合成率对多发性硬化的诊断价值

目的探讨寡克隆带(OCBs)和IgG鞘内合成率(IgGSyn)对多发性硬化(MS)诊断的敏感性、特异性,以及定性和定量指标的相关性。方法选取30例MS(MS组)、40例神经系统炎性疾病(NID组)和22例神经系统非炎性疾病(NNID组)患者,应用速率散射比浊法测定血清和脑脊液(CSF)中免疫球蛋白G(IgG)、白蛋白(Alb)水平,等电聚焦结合银染色法检测CSF中OCBs,计算IgGSyn,并对其敏感性、特异性和阳性结果似然比(PRLR)进行分析。结果OCBs阳性率和IgGSyn异常率MS组与NID组比较差异无显著性;MS组、NID组与NNID组比较差异有极显著性(均P<0.01)。MS组和NID组中,OCBs阳性者与阴性者IgGSyn值差异无显著性。对MS诊断的敏感性、特异性和PRLR,OCBs分别为63.3%、77.7%和2.8;IgGSyn为46.7%、75.2%和1.9。结论OCBs和IgGSyn检测结果的不完全一致性提示中枢神经系统内存在不同的体液免疫反应机制,综合分析OCBs和IgGSyn,对MS诊断具有参考价值。

Diagnostic value of oligoclonal bands and intrathecal IgG synthesis rate in multiple sclerosis

Objective To study the sensitivity and specificity of oligoclonal bands (OCBs) and intrathecal IgG synthesis rate (IgG Syn) for diagnosis of multiple sclerosis (MS) and the correlation between qualitative and quantitative indices.Methods Albumin and IgG concentrations in the cerebrospinal fluid (CSF) and serum from 30 patients with MS, 40 with other nervous system inflammatory diseases (NID) and 22 with nervous system noninflammatory diseases (NNID) were determined by rate nephelometry method. OCBs in the CSF were detected using isoelectric focusing combined with silver staining, and IgG Syn was calculated. The sensitivity, specificity and positive result likelihood ratio (PRLR) were analyzed.Results There were no significant difference in the abnormal rate of OCBs and IgG Syn between MS group and NID group. When MS and NID groups were compared with NNID group, the difference was extremely significant (all P<0.01).The amount of IgG Syn was no different significantly between patients with or without OCBs in the MS and NID groups.For diagnosis of MS,the sensitivity, specificity and PRLR of OCBs were 63.3%, 77.7% and 2.8 respectively;those of IgG Syn were 46.7%, 75.2% and 1.9.Conclusions The inconsistency between OCBs and IgG Syn indicates there exists different humoral immune responses in the CNS. OCBs and IgG Syn can be used to aggregate analysis of clinical problems and they are helpful to diagnose of MS.