脑脊液寡克隆区带及鞘内IgG合成相关指标分析在多发性硬化症诊断中的应用

Clinical significance of CSF-OCB and intrathecal IgG synthesis related indicators in multiple sclerosis

目的探讨脑脊液特异寡克隆区带(CSF-OCB)及鞘内免疫球蛋白G(IgG)合成相关指标分析在多发性硬化(MS)诊断中的意义。方法回顾性分析2014年1月至2017年12月于北京天坛医院确诊的77例MS患者的临床资料,并选取同期非MS患者493例为对照组,包括视神经脊髓炎(NMO)97例(NMO组),格林巴利综合征(GBS)67例(GBS组),神经系统炎性疾病(NID)86例(NID组),神经系统非炎性疾病(NIND)243例(NIND组)。采用琼脂糖凝胶等电聚焦法测定CSF-OCB,速率散射比浊法定量检测IgG和清蛋白(Alb),利用公式计算IgG指数、24hIgG合成率,并分析上述相关指标对MS的诊断意义。结果 MS组CSFOCB阳性率明显高于对照组各组,差异均有统计学意义(P<0.01)。MS组与NMO组、NID组、NIND组IgG指数比较,差异均有统计学意义(P_1<0.01)。MS组与NMO组及NIND组24hIgG合成率比较,差异均有统计学意义(P<0.01)。结论 CSF-OCB、IgG指数、24hIgG合成率测定,尤其是明确CSF-OCB,对MS的诊断和鉴别诊断具有重要临床意义。

Objective To investigate the clinical significances of oligoclonal band（OCB）and intrathecal immunoglobulin G（IgG）synthesis related indicators in patients with multiple sclerosis（MS）.Methods The clinical data of 77 patients with multiple sclerosis confirmed by Beijing Tiantan Hospital from January 2014 to December 2017 were analyzed retrospectively.493 cases of non-multiple sclerosis during the same period were selected as the control group including 97 cases of Neuromyelitis Optica（NMO）,67 cases of Guillain-Barre syndrome（GBS）,86 cases of neurological inflammatory disease（NID）and 243 cases of neurological non-inflammatory disease（NIND）.CSF-OCB was measured by agarose gel isoelectric focusing,and levels of IgG and albumin（Alb）were quantitatively detected by rate scattering turbidimetry.The IgG index and 24 hIgG synthesis rate were calculated by using the formula,and the diagnostic significance of the above related indicators for MS was analyzed.Results The positive rate of CSF-OCB in MS group was significantly higher than that in control group（P0.05）.There was a statistically significant difference in IgG index between MS group and NMO group,NID group and NIND group（P_10.05）.There was a statistical difference in the 24 hIgG synthesis rate between MS group and NMO group and NIND group（P20.05）.Conclusion The determinations of CSF-OCB,IgG index and 24 hIgG synthesis rate,especially the determination of CSF-OCB,have important clinical significance in the diagnosis and differential diagnosis of MS.