Miró J, Aguayo F, Garrido J C, Alvarez C, Polo J M, Pascual J, Berciano J
Department of Neurology, Cantabria University Hospital, Marqués de Valdecilla, Faculty of Medicine, Santander, Spain.
Eur Neurol. 1992;32(6):349-53. doi: 10.1159/000116859.
The objective of this study was to investigate quantitative and qualitative intrathecal IgG synthesis in 51 patients with clinically definite multiple sclerosis, taking previous immunosuppressive treatment into account. Four formulae were used to assess quantitative synthesis. Oligoclonal bands (OB) were investigated using isoelectric focusing (IEF) and silver staining. Abnormal quantitative values were detected in 42 (82%) patients, whereas OB occurred in 38 (74.5%) patients. Steroid therapy lowered quantitative synthesis in 6 out of 9 patients when given within 3 months before lumbar puncture (LP). Untreated patients with OB systematically had abnormal formulae. Patients treated with corticosteroids 10 or more months prior to LP had abnormal formulae. This fact suggests a transient depressor effect of steroids on quantitative synthesis. OB were present in patients recently treated with corticosteroids. Quantitative synthesis was higher in patients with OB than in those without OB. Azathioprine treatment did not significantly lower quantitative synthesis. We conclude that for routine purposes evaluation of intrathecal immunoglobulin synthesis could begin by performing quantitative tests. IEF seems to be mandatory for patients with normal formulae who have recently been treated with steroids.
本研究的目的是在考虑既往免疫抑制治疗的情况下，调查51例临床确诊的多发性硬化症患者鞘内IgG的定量和定性合成情况。使用了四种公式来评估定量合成。采用等电聚焦（IEF）和银染法检测寡克隆带（OB）。42例（82%）患者检测到定量值异常，而38例（74.5%）患者出现OB。在腰椎穿刺（LP）前3个月内给予类固醇治疗时，9例患者中有6例的定量合成降低。未经治疗且有OB的患者系统性地存在公式异常。在LP前10个月或更长时间接受皮质类固醇治疗的患者有公式异常。这一事实表明类固醇对定量合成有短暂的抑制作用。近期接受皮质类固醇治疗的患者存在OB。有OB的患者的定量合成高于无OB的患者。硫唑嘌呤治疗并未显著降低定量合成。我们得出结论，出于常规目的，鞘内免疫球蛋白合成的评估可以从进行定量检测开始。对于公式正常但近期接受过类固醇治疗的患者，IEF似乎是必需的。
