Reiber Hansotto
Former Neurochemistry Laboratory, Georg August-University, Goettingen, Germany.
Arq Neuropsiquiatr. 2016 Apr;74(4):337-50. doi: 10.1590/0004-282X20160044.
The analysis of intrathecal IgG, IgA and IgM synthesis in cerebrospinal fluid (CSF) and evaluation in combined quotient diagrams provides disease-related patterns. The compilation with complementary parameters (barrier function, i.e., CSF flow rate, cytology, lactate, antibodies) in a cumulative CSF data report allows a knowledge-based interpretation and provides analytical and medical plausibility for the quality assessment in CSF laboratories. The diagnostic relevance is described for neurological and psychiatric diseases, for which CSF analysis can't be replaced by other diagnostic methods without loss of information. Dominance of intrathecal IgM, IgA or three class immune responses give a systematic approach for Facial nerve palsy, Neurotrypanosomiasis, Opportunistic diseases, lymphoma, Neurotuberculosis, Adrenoleucodystrophy or tumor metastases. Particular applications consider the diagnostic power of the polyspecific antibody response (MRZ-antibodies) in multiple sclerosis, a CSF-related systematic view on differential diagnostic of psychiatric diseases and the dynamics of brain- derived compared to blood-derived molecules in CSF for localization of paracytes.
对脑脊液(CSF)中鞘内IgG、IgA和IgM合成的分析以及在综合商图中的评估可提供与疾病相关的模式。在累积的脑脊液数据报告中纳入补充参数(屏障功能,即脑脊液流速、细胞学、乳酸、抗体),有助于进行基于知识的解读,并为脑脊液实验室的质量评估提供分析和医学合理性依据。文中描述了脑脊液分析对于神经和精神疾病的诊断相关性,对于这些疾病而言,脑脊液分析在不损失信息的情况下无法被其他诊断方法所取代。鞘内IgM、IgA占优势或三类免疫反应为面神经麻痹、神经锥虫病、机会性疾病、淋巴瘤、神经结核病、肾上腺脑白质营养不良或肿瘤转移提供了系统的诊断方法。具体应用包括多特异性抗体反应(MRZ抗体)在多发性硬化症中的诊断能力、基于脑脊液的精神疾病鉴别诊断系统观点,以及脑脊液中脑源性分子与血源性分子相比在副细胞定位方面的动态变化。