Valkov Trifon, Hristova Julieta, Tcherveniakova Tatiana, Svinarov Dobrin
Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases "Prof. Ivan Kirov", Sofia, Bulgaria; Dept. of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University, Sofia, Bulgaria.
Dept. of Clinical Laboratory and Clinical Immunology, Faculty of Medicine, Medical University, Sofia, Bulgaria; Clinical Laboratory and Clinical Pharmacology, Alexandrovska University Hospital, Sofia, Bulgaria.
Infez Med. 2017 Dec 1;25(4):320-325.
Cerebrospinal fluid/serum albumin ratio is one of the most informative parameters for blood-brain barrier (BBB) integrity in cases of central nervous system (CNS) infectious diseases. Normally, CNS albumin concentration is a function of diffusion processes along with CSF drainage and resorption. In pathological processes CSF albumin levels are dependent only on the rate of CSF drainage resulting in non-linear reciprocal changes of albumin quotient (Qalb). IgG, IgA and IgM concentrations both in CSF and serum can be compared to Qalb, thus determining the intrathecal immune response. The aim of the study was to detect BBB permeability impairment and the intrathecal immune response in patients with CNS infections with various etiologies. CSF/serum ratios were calculated and related to IgG IgA and IgM concentrations in CSF and blood serum. The results were integrated and presented by Reibergrams. The results demonstrated typical patterns which prove albumin to be the main modulator of protein dynamics and at the same time explicates the complex pathophysiological mechanisms involved in BBB disruption and intrathecal immune response in CNS infections. The diagnostic model presented in our study seeks to explain the observations of meningitis and meningoencephalitis pathophysiology and points out the mandatory cooperation between clinicians and laboratory for accurate diagnosis and proper treatment.
脑脊液/血清白蛋白比值是中枢神经系统（CNS）感染性疾病中评估血脑屏障（BBB）完整性最具信息量的参数之一。正常情况下，中枢神经系统白蛋白浓度是扩散过程以及脑脊液引流和重吸收的函数。在病理过程中，脑脊液白蛋白水平仅取决于脑脊液引流速率，导致白蛋白商（Qalb）呈非线性反比变化。脑脊液和血清中的IgG、IgA和IgM浓度可与Qalb进行比较，从而确定鞘内免疫反应。本研究的目的是检测不同病因的中枢神经系统感染患者的血脑屏障通透性损害和鞘内免疫反应。计算脑脊液/血清比值，并将其与脑脊液和血清中的IgG、IgA和IgM浓度相关联。结果通过赖伯格图进行整合和呈现。结果显示出典型模式，证明白蛋白是蛋白质动力学的主要调节因子，同时也阐明了中枢神经系统感染中血脑屏障破坏和鞘内免疫反应所涉及的复杂病理生理机制。我们研究中提出的诊断模型旨在解释脑膜炎和脑膜脑炎病理生理学的观察结果，并指出临床医生和实验室之间为准确诊断和合理治疗进行强制性合作的必要性。
