Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW, Australia.
Pathology. 2012 Apr;44(3):248-50. doi: 10.1097/PAT.0b013e3283511a87.
Detection of oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF) is an important adjunct to the diagnosis of multiple sclerosis (MS) and clinically isolated syndromes (CIS). OCBs are considered present if two or more extra IgG bands are present in CSF in comparison to a simultaneously collected serum sample. However, using isoelectric focusing and immunofixation with anti-IgG, we observed two distinct banding patterns, one in which the bands were numerous and prominent (which we termed 'delta') and a much more subtle pattern, with fewer, more indistinct bands ('theta').
To perform a prospective study to determine the diagnostic implications of the two OCB patterns for multiple sclerosis.
Over a 2-year period, 56 consecutive CSF samples with OCBs were identified. Clinical information and radiological data were collected and correlated with the two banding patterns.
: Of the 56 positive CSF samples, 46 (82%) demonstrated a delta pattern, and 10 (18%), a theta pattern. The delta pattern was associated with MS/CIS in 34 of 46 (74%) samples, compared with zero of the 10 theta samples (0%, p < 0.001). Exclusion of the theta pattern samples increased the positive predictive value of OCB testing from 61% to 74% for MS/CIS.
The diagnostic significance of oligoclonal bands in CSF for MS/CIS can be improved by restricting interpretation to the delta banding pattern alone.
脑脊液（CSF）中寡克隆带（OCB）的检测是多发性硬化症（MS）和临床孤立综合征（CIS）诊断的重要辅助手段。如果 CSF 中同时检测到两个或更多额外的 IgG 带，与同时采集的血清样本相比，OCB 被认为存在。然而，使用等电聚焦和免疫固定技术检测抗 IgG，我们观察到两种不同的带型模式，一种是带型数量众多且明显（我们称之为“δ”），另一种是更微妙的模式，带型数量较少且不明显（“θ”）。
进行一项前瞻性研究，以确定这两种 OCB 模式对多发性硬化症的诊断意义。
在两年期间，确定了 56 例连续的 CSF 中存在 OCB 的样本。收集临床信息和放射学数据，并与两种带型模式相关联。
在 56 例阳性 CSF 样本中，46 例（82%）表现出δ模式，10 例（18%）表现出θ模式。在 46 例δ模式样本中，34 例（74%）与 MS/CIS 相关，而在 10 例θ模式样本中，没有 1 例（0%，p<0.001）与 MS/CIS 相关。排除θ模式样本后，OCB 检测对 MS/CIS 的阳性预测值从 61%提高到 74%。
通过将解释仅限于δ带型模式，可以提高 CSF 中 OCB 对 MS/CIS 的诊断意义。
