脑脊液转铁蛋白、免疫球蛋白G、C反应蛋白和α_1-微球蛋白检测在血-脑脊液屏障损伤评价中的应用

Determination of Levels of Cerebrospinal Fluid Transferrin,IgG,CRP and α_1-MG in Evaluation of Blood-brain Barrier Injury

目的探讨脑脊液转铁蛋白、免疫球蛋白G(IgG)、C反应蛋白(CRP)和α1-微球蛋白(α1-MG)检测在血-脑脊液屏障(Blood-brain barrier,BBB)损伤评价中的应用价值。方法采用散射比浊法检测BBB不同程度损伤患者脑脊液中的清蛋白、转铁蛋白、IgG、CRP和α1-MG的水平。结果随着BBB损伤的加重,脑脊液中转铁蛋白和IgG水平均增高,且不同程度BBB损伤组间脑脊液转铁蛋白和IgG水平比较差异有统计学意义(P<0.01);脑脊液转铁蛋白和IgG与清蛋白商值均呈正相关(r值分别为0.853和0.834,P<0.01);脑脊液转铁蛋白和IgG的受试者工作特征曲线(ROC)下面积(AUC)分别为0.992和0.970;脑脊液转铁蛋白和IgG在BBB损伤诊断中的灵敏度、特异度分别为94.2%和95.5%、94.2%和91.9%;6例患者脑脊液CRP水平增高,但所有患者α1-MG水平<5.29mg/L。结论脑脊液转铁蛋白测定是反映BBB损伤的良好指标;在排除中枢神经系统内无免疫球蛋白产生的情况下,脑脊液IgG测定可以反映BBB的功能状态;脑脊液中出现CRP表明BBB损伤且外周血中CRP水平增高;脑脊液α1-MG检测在BBB损伤评价中无意义。

Objective To evaluate the determination of cerebrospinal fluid transferrin, immunoglobulin G （ IgG）, C - reactive protein （CRP） and α1 - MG in evaluation of blood - brain barrier （BBB） injury. Methods Nephelometry was used to determine the concentrations of transferrin, IgG, CRP and α1 - MG in cerebrospinal fluid of patients with BBB injury. Results With the aggravation of BBB injury, the concentrations of transferrin and IgG increased, and there was significant difference between groups with different degrees of BBB injuries （P 〈0. 01 ）. Cerebrospinal fluid transferrin and IgG were positively correlated with albumin quotient （ r =0. 853, 0. 834, respectively, P 〈0. 01 ）. The ROC curve AUC of transferrin and IgG was 0. 992, 0. 970, respectively, and in diagnosis of BBB injury the sensitivities of transferrin and IgG were 94. 2%, 94.2%, respectively, and the specificity 95.5%, 91.9%, respectively. The cerebrospinal fluid CRP concentration increased in 6 patients, but α1 - MG concentration was under the detectable limitation （5. 29 mg/L） in all patients. Conclusion Deter- mination of cerebrospinal fluid is a good indicator reflecting BBB injury. IgG detection can reflect BBB functional status when no immune globulin was produced in central nervous system. The presence of CRP in cerebrospinal fluid shows injured BBB and increased CRP in peripheral blood. The detection of α1 - MG in cerebrospinal fluid is of no significance in evaluation of BBB injury.