寡克隆区带和IgG指数对多发性硬化的诊断价值

目的　探讨寡克隆区带 (OCB)和IgG指数对多发性硬化 (MS)诊断的敏感性及特异性。方法　收集 4 8例MS、6 8例神经系统炎性疾病 (NID)及 110例非炎性疾病 (NNID) 3组患者的脑脊液 (CSF)和血清标本 ,分别进行OCB的检测 (等电聚焦 )和IgG指数的计算。并对其阳性结果似然比 (PRLR)进行分析。结果　MS组与NID组比较 ,CSF中OCB阳性率和IgG指数异常率的差异均没有显著性 (均P >0 0 5 ) ;但MS组、NID组与NNID组比较 ,差异均有极显著性 (均P <0 0 0 0 1)。MS组CSF中OCB和IgG指数的敏感性分别为 39 6 %、6 0 4 % ;特异性分别为 80 3%、72 1% ;PRLR分别为 2 0、2 2。当用于判断有无IgG鞘内合成时 ,特异性分别为 97 2 %、92 7% ;PRLR分别为 13 5、7 3。结论　CSF中OCB阳性和IgG指数升高强烈提示有中枢神经系统局部IgG合成 ,对MS有一定的辅助诊断价值

Diagnostic value of the oligoclonal bands and IgG index in multiple sclorosis

Objective To investigate the sensitivity and specificity of the oligoclonal bands(OCB) and the IgG index(IgGI) in the diagnosis of multiple sclerosis(MS).Methods The OCB in cerebrospinal fluid(CSF) and serum collected from 48 patients of MS, 68 patients of other nervous system inflammatory diseases(NID) and 110 patients of nervous system non-inflammatory diseases(NNID) were detected using isoelectric focusing and the IgGI was calculated.Their positive result likelihood ratio(PRLR) was analysed.Results There was no significant difference both in positive rate of CSF OCB and IgGI between MS group and NID group(all P>0.05). When MS and NID groups compared with NNID group, the difference was extremely significant(all P<0.0001). In MS group, the sensitivity, specificity and PRLR of CSF OCB were 39.6%, 80.3% and 2.0 respectively whereas those of IgGI were 60.4%, 72.1% and 2.2 respectively. When CSF OCB and IgGI were used to judge whether there was intrathecally synthesized IgG, the specificity was 97.2% and 92.7% respectively and the PRLR was 13.5 and 7.3 respectively.Conclusion The presence of CSF-restricted OCB or increased IgGI strongly suggests that there is intrathecally synthesized IgG, which is helpful to the diagnosis of MS.