两种判定鞘内合成方法的应用评价

Evaluation on the application of two methods for determining intrathecal synthesis

目的通过分析神经系统疾病患者脑脊液(CSF)标本中抗体来源,对两种判定鞘内合成的检测指标进行应用评价。方法选取2013年12月至2017年7月首都医科大学附属北京天坛医院366份配对送检血清和CSF标本,分别检测5种神经系统疾病相关病毒的IgG和IgM抗体、清蛋白含量及脑脊液寡克隆区带(CSF-OCB)。根据血脑屏障(BBB)完整程度将患者分为BBB正常组(190例)、轻度损伤组(66例)、中度损伤组(85例)和重度损伤组(23例),计算各组24h鞘内IgG合成率(IgG syn)、IgG指数(IgG I),以CSF-OCB结果为金标准,分析IgG syn、IgG I与其符合程度。结果 IgG I在BBB轻、中、重度受损时,与CSF-OCB的阴性符合率(分别为95.24%、82.14%、71.43%)高于阳性符合率(分别为33.33%、51.72%、55.56%),可作为排除鞘内合成的指标;IgG syn在BBB正常或轻度受损时,与CSF-OCB的阴性符合率(分别为77.06%、90.48%)高于阳性符合率(分别为40.74%、37.50%),可用于排除鞘内合成,而在中度或重度受损时,与CSF-OCB则表现为阳性符合率(分别为58.62%、88.89%)高于阴性符合率(分别为57.14%、21.43%),可用于明确鞘内合成情况的存在。结论根据患者BBB完整程度选择判定鞘内合成的检测方法,可为临床明确诊断提供帮助。

Objective To analyze the source of antibodies in cerebrospinal fluid（CSF）samples from patients with neurological diseases and evaluate the application of two detection indicators for intrathecal synthesis.Methods 366 paired serum and CSF samples from Beijing Tiantan Hospital Affiliated to Capital Medical University from December 2013 to July 2017 were selected to detect IgG and IgM antibodies,albumin content and CSF-OCB of five kinds of nervous system disease-related viruses respectively.According to the integrity of blood-brain barrier（BBB）,patients were divided into normal BBB group（190 cases）,mild injury group（66 cases）,moderate injury group（85 cases）and severe injury group（23 cases）.The intrathecal IgG synthesis rate（IgG syn）and IgG index（IgG I）were calculated for 24 hin each group.The result of CSF-OCB was taken as the gold standard and IgG syn,IgG I and their coincidence were analyzed.Results When BBB was damaged mildly,moderately or severely,the negative compliance rates between IgG I and CSF-OCB（95.24%,82.14%and 71.43%respectively）were higher than the positive compliance rates（33.33%,51.72% and 55.56%respectively）,and IgG I can be used as an exclusion index in the determination of intrathecal synthesis.When BBB was normal or damaged mildly,the negative compliance rates（77.06% and 90.48% respectively）between IgG syn and CSF-OCB were higher than the positive compliance rates（40.74%and 37.50%respectively）,and IgG syn can be used to exclude intrathecal synthesis.However,when BBB was damaged moderately or severely,the positive compliance rates between IgG syn and CSF-OCB（58.62%and 88.89%respectively）were higher than the negative compliance rates（57.14%and 21.43%respectively）,so IgG syn can be helpful for the definitive diagnosis of intrathecal synthesis.Conclusion Different detection methods should be selected according to the integrity of BBB,thus providing help for disease diagnosis.