PDF(Pubmed)
Abstract：
Multiple sclerosis is a chronic immune-mediated disorder of the central nervous system with a high heterogeneity among patients. In the clinical setting, one of the main challenges is a proper and early diagnosis for the prediction of disease activity. Current diagnosis is based on the integration of clinical, imaging, and laboratory results, with the latter based on the presence of intrathecal IgG oligoclonal bands in the cerebrospinal fluid whose detection via isoelectric focusing followed by immunoblotting represents the gold standard. Intrathecal synthesis can also be evidenced by the measurement of kappa free light chains in the cerebrospinal fluid, which has reached similar diagnostic accuracy compared to that of oligoclonal bands in the identification of patients with multiple sclerosis; moreover, recent studies have also highlighted its value for early disease activity prediction. This strategy has significant advantages as compared to using oligoclonal band detection, even though some issues remain open. Here, we discuss the current methods applied for cerebrospinal fluid analysis to achieve the most accurate diagnosis and for follow-up and prognosis evaluation. In addition, we describe new promising biomarkers, currently under investigation, that could contribute both to a better diagnosis of multiple sclerosis and to its monitoring of the therapeutic treatment response.
摘要：
多发性硬化症是一种慢性免疫介导的中枢神经系统疾病，患者之间存在高度异质性。在临床上，主要挑战之一是正确和早期诊断以预测疾病活动。目前的诊断是基于临床的整合，成像,和实验室结果，后者基于脑脊液中鞘内IgG寡克隆带的存在，通过等电聚焦然后免疫印迹的检测代表了金标准。鞘内合成也可以通过测量脑脊液中的κ游离轻链来证明，在多发性硬化症患者的鉴定中，与寡克隆带相比，达到了相似的诊断准确性；此外，最近的研究也强调了它对早期疾病活动预测的价值。与使用寡克隆条带检测相比，该策略具有显着的优势，尽管有些问题仍然存在。这里,我们讨论了当前用于脑脊液分析的方法，以实现最准确的诊断以及随访和预后评估。此外,我们描述了新的有希望的生物标志物，目前正在调查中,这可能有助于更好地诊断多发性硬化症和监测治疗反应。
