Zeman David, Kušnierová Pavlína, Bartoš Vladimír, Hradílek Pavel, Kurková Barbora, Zapletalová Olga
Department of Clinical Biochemistry, Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava-Poruba, Czech Republic Clinic of Neurology, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
Department of Clinical Biochemistry, Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava-Poruba, Czech Republic.
Ann Clin Biochem. 2016 Jan;53(Pt 1):174-6. doi: 10.1177/0004563215579110. Epub 2015 Mar 9.
The results of free light chains quantitation in the cerebrospinal fluid were recently compared with the presence of cerebrospinal fluid-restricted oligoclonal IgG, but not oligoclonal free kappa light chains and oligoclonal free lambda light chains. We therefore aimed to compare the performance of the quantitative tests with the qualitative one for the same molecule.
Seventy-five paired cerebrospinal fluid and serum samples were analysed for oligoclonal IgG, oligoclonal free kappa light chains and oligoclonal free lambda light chains. Cerebrospinal fluid and serum free kappa and lambda light chains were quantified using Freelite™ kits on SPA Plus analyzer. ROC curves were analysed for the prediction of intrathecal synthesis and compared for cerebrospinal fluid concentration, cerebrospinal fluid/serum quotient (QfLC) and index (QfLC/QAlbumin). The presence of cerebrospinal fluid-restricted oligoclonal free kappa light chains and oligoclonal free lambda light chains bands was used as reference.
No statistically significant differences were observed among cerebrospinal fluid concentration, QfLC and index for the prediction of free light chain intrathecal synthesis. Each parameter was able to predict the occurrence of cerebrospinal fluid-restricted oligoclonal free light chain bands (AUCs 0.932-0.999). However, we noted elevated cerebrospinal fluid free light chain concentrations in the absence of cerebrospinal fluid-restricted oligoclonal free light chain bands in two patients with very high serum free light chain values.
Quantitation of cerebrospinal fluid free light chains reliably predicts their intrathecal synthesis. Yet, cerebrospinal fluid/serum quotient may still be preferred to correct for high serum free light chain concentrations. An appropriate formula should be sought to correct for blood-cerebrospinal fluid barrier status.
最近对脑脊液中游离轻链定量结果与脑脊液限制性寡克隆IgG的存在情况进行了比较，但未涉及寡克隆游离κ轻链和寡克隆游离λ轻链。因此，我们旨在比较同一分子定量检测与定性检测的性能。
对75对脑脊液和血清样本进行寡克隆IgG、寡克隆游离κ轻链和寡克隆游离λ轻链分析。使用Freelite™试剂盒在SPA Plus分析仪上对脑脊液和血清中的游离κ和λ轻链进行定量。分析ROC曲线以预测鞘内合成，并比较脑脊液浓度、脑脊液/血清商（QfLC）和指数（QfLC/Q白蛋白）。以脑脊液限制性寡克隆游离κ轻链和寡克隆游离λ轻链条带的存在作为参考。
在预测游离轻链鞘内合成方面，脑脊液浓度、QfLC和指数之间未观察到统计学显著差异。每个参数都能够预测脑脊液限制性寡克隆游离轻链条带的出现（AUC为0.932 - 0.999）。然而，我们注意到在两名血清游离轻链值非常高的患者中，在没有脑脊液限制性寡克隆游离轻链条带的情况下，脑脊液游离轻链浓度升高。
脑脊液游离轻链定量可可靠地预测其鞘内合成。然而，脑脊液/血清商可能仍然更适合用于校正高血清游离轻链浓度。应寻求合适的公式来校正血脑屏障状态。
