Sharief M K, Thompson E J
Department of Clinical Neurochemistry, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
Ann Neurol. 1991 Feb;29(2):147-51. doi: 10.1002/ana.410290206.
The intrathecal synthesis of IgM in patients presenting with acute monosymptomatic syndromes may be relevant in predicting eventual progression to multiple sclerosis but has not been previously evaluated. We undertook a prospective 18-month combined clinical, cerebrospinal fluid, and magnetic resonance imaging study of 45 patients who had presented with acute isolated lesions of brainstem and spinal cord to evaluate the predictive value of intrathecal synthesis of IgM and IgG (through the detection of cerebrospinal fluid oligoclonal bands) and magnetic resonance imaging brain lesions at presentation, for the subsequent progression to multiple sclerosis. Results indicate that the highest risk of developing multiple sclerosis is seen in patients who are positive for oligoclonal IgM and IgG bands and who have disseminated cerebral white matter magnetic resonance imaging lesions at the initial presentation. Oligoclonal IgM bands predict progression to multiple sclerosis more frequently than oligoclonal IgG or magnetic resonance imaging alone. Our results confirm and further extend previous reports, and indicate that detection of cerebrospinal fluid oligoclonal IgM bands at presentation is a valuable prognostic indicator in patients presenting with acute isolated brainstem or spinal cord syndromes.
急性单症状综合征患者鞘内IgM的合成可能与预测最终发展为多发性硬化症有关，但此前尚未得到评估。我们对45例出现脑干和脊髓急性孤立性病变的患者进行了一项为期18个月的前瞻性综合临床、脑脊液和磁共振成像研究，以评估鞘内IgM和IgG合成（通过检测脑脊液寡克隆带）以及初次就诊时磁共振成像脑病变对随后发展为多发性硬化症的预测价值。结果表明，寡克隆IgM和IgG带阳性且初次就诊时出现弥漫性脑白质磁共振成像病变的患者发生多发性硬化症的风险最高。寡克隆IgM带比寡克隆IgG或单独的磁共振成像更频繁地预测进展为多发性硬化症。我们的结果证实并进一步扩展了先前的报告，并表明在初次就诊时检测脑脊液寡克隆IgM带是急性孤立性脑干或脊髓综合征患者的一个有价值的预后指标。
