脑脊液(CSF)中存在≥3个寡克隆带(OCB),而血清中没有相应的带代表了明确的病理模式,而1-2条CSF条带(临界模式)的临床意义研究甚少。
我们筛选了1986年连续的CSF和血清样品,这些样品是在四年的时间内收集的,并获得了等电聚焦(IEF)的结果。对于临界OCB患者,我们回顾了各个医学图表,以评估临床诊断。在可行的情况下,重复IEF并获得后续样品的结果。使用聚丙烯酰胺凝胶进行IEF,然后进行免疫印迹和IgG特异性抗体染色。此外,我们使用不同的CSF限制带截断值对OCB的诊断特异性进行了系统文献综述.
在253名临界OCB患者中,21.7%患有中枢神经系统炎症性神经系统疾病(IND),包括4%的多发性硬化症患者,14.2%有外周IND,而其余64.1%的患者表现为非炎症性疾病。一个或两个没有相应血清带的CSF带的频率在疾病组之间没有差异。在100名患者的亚组中重复IEF。其中,73%为OCB阴性,而没有样本是阳性的。在中位数为27个月后收集的随访样本中,有26例患者的IEF结果可用。其中,4(15.4%)转正。系统文献综述显示,在主要患有非炎性神经系统疾病的患者中,使用≥3和≥2条CSF带的OCB诊断特异性分别为97%和92%。
一个或两个CSF限制带的临床意义是中等的,因此,表明鞘内B细胞活性的可能但不可靠的证据。样品重新测试,引入额外的诊断类别,例如“可能的鞘内IgG合成”,和后续腰椎穿刺可能是解决这种情况的可能选择。
The presence of ≥3 oligoclonal bands (OCB) in the cerebrospinal fluid (CSF) without corresponding bands in serum represents a definite pathological pattern, whereas the clinical significance of 1-2 CSF bands (borderline pattern) is poorly investigated.
We screened 1986 consecutive CSF and serum samples which were collected over a four-year time period and had results of isoelectric focusing (IEF) available. Of patients with borderline OCB we reviewed individual medical charts for assessment of clinical diagnoses. Where feasible, IEF was replicated and results of follow-up samples were obtained. IEF was performed using polyacrylamide gel followed by immunoblotting and IgG-specific antibody staining. Additionally, we performed a systematic literature
review of the diagnostic specificity of OCB using different cut-offs for CSF-restricted bands.
Out of 253 patients with borderline OCB, 21.7% had an inflammatory neurological disease (IND) of the central nervous system, comprising 4% multiple sclerosis patients, and 14.2% had a peripheral IND, whereas the remaining 64.1% of patients showed non-inflammatory diseases. Frequency of one or two CSF bands without corresponding serum bands did not differ between the disease groups. In a subgroup of 100 patients IEF was repeated. Of those, 73% were OCB negative, while no sample was positive. In 26 patients IEF results were available of a follow-up sample collected after a median of 27 months. Of those, 4 (15.4%) turned positive. Systematic literature
review revealed a diagnostic specificity of OCB of 97% and 92% using a cut-off ≥3 and ≥2 CSF bands in patients with mainly non-inflammatory neurological diseases.
The clinical significance of one or two CSF-restricted bands is moderate and, hence, indicates a possible but not reliable proof of intrathecal B-cell activity. Sample re-testing, introduction of an additional diagnostic category, e.g. \"possible intrathecal IgG synthesis\", and follow-up lumbar puncture might be possible options to address this scenario.