Division of Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Acta Neurol Scand. 2012 Feb;125(2):129-35. doi: 10.1111/j.1600-0404.2011.01511.x. Epub 2011 Mar 24.
Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) are autoimmune diseases of the peripheral nervous system. A clinical hallmark of GBS and CIDP is the albumino-cytologic dissociation in the cerebrospinal fluid (CSF). Changes in the CSF levels of proteins other than albumin in patients with GBS and CIDP are not as well studied. If altered, aberrant levels of CSF proteins may render it possible to establish useful biomarkers for GBS and CIDP.
Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of prealbumin, fibrinogen, haptoglobin, apolipoprotein E, apolipoprotein A4 in both CSF and plasma samples from 19 patients with GBS and eight with CIDP, 24 controls with multiple sclerosis (MS) as well as 20 patients with other non-inflammatory neurological disorders (OND).
The levels of prealbumin in both the plasma and the CSF were elevated in patients with GBS and MS compared with the controls. The higher levels of fibrinogen were seen in the CSF of patients with GBS and CIDP, but not in the plasma. The levels of CSF prealbumin and fibrinogen, measured by the CSF index of these proteins, were lower in patients with GBS and that of fibrinogen in patients with CIDP compared with controls with OND. Haptoglobin levels in the CSF rather than in the plasma were higher in patients with GBS and CIDP than in controls. The CSF haptoglobin index was higher in patients with CIDP and MS, but not in those with GBS. No correlation was found between levels of CSF proteins and clinical parameters in patients with GBS and CIDP.
Our data provide preliminary evidence that GBS is associated with low CSF index levels of prealbumin and fibrinogen, but normal levels of haptoglobin, whereas CIDP is associated with normal CSF index levels of prealbumin, low fibrinogen, and high levels of haptoglobin. Further studies are needed to identify the underlying mechanisms behind these CSF protein alterations and to clarify whether prealbumin, fibrinogen, and haptoglobin can serve as useful biomarkers for GBS and CIDP.
吉兰-巴雷综合征（GBS）和慢性炎症性脱髓鞘性多发性神经病（CIDP）是周围神经系统的自身免疫性疾病。GBS 和 CIDP 的一个临床特征是脑脊液（CSF）中的蛋白-细胞分离。GBS 和 CIDP 患者除白蛋白外，CSF 中其他蛋白质水平的变化尚未得到充分研究。如果发生改变，CSF 蛋白质的异常水平可能使其有可能建立 GBS 和 CIDP 的有用生物标志物。
采用酶联免疫吸附测定（ELISA）法测量 19 例 GBS 患者和 8 例 CIDP 患者的 CSF 和血浆样本中的前白蛋白、纤维蛋白原、触珠蛋白、载脂蛋白 E、载脂蛋白 A4 水平，以及 24 例多发性硬化症（MS）对照组和 20 例其他非炎症性神经系统疾病（OND）患者。
与对照组相比，GBS 和 MS 患者的血浆和 CSF 前白蛋白水平均升高。GBS 和 CIDP 患者的 CSF 中纤维蛋白原水平较高，但血浆中没有。GBS 患者 CSF 前白蛋白和纤维蛋白原的 CSF 指数测量值以及 CIDP 患者的纤维蛋白原水平均低于 OND 对照组。GBS 和 CIDP 患者的 CSF 触珠蛋白水平高于对照组，而非血浆。CIDP 和 MS 患者的 CSF 触珠蛋白指数较高，但 GBS 患者没有。GBS 和 CIDP 患者的 CSF 蛋白水平与临床参数之间无相关性。
我们的数据提供了初步证据，表明 GBS 与 CSF 前白蛋白和纤维蛋白原指数水平降低有关，而与触珠蛋白正常有关，而 CIDP 与 CSF 前白蛋白指数正常、纤维蛋白原降低和触珠蛋白水平升高有关。需要进一步研究以确定这些 CSF 蛋白改变的潜在机制，并阐明前白蛋白、纤维蛋白原和触珠蛋白是否可作为 GBS 和 CIDP 的有用生物标志物。
