Bonnan Mickael, Gianoli-Guillerme Mariana, Courtade Henri, Demasles Stéphanie, Krim Elsa, Marasescu Raluca, Dréau Hervé, Debeugny Stéphane, Barroso Bruno
Service de neurologie Centre Hospitalier de Pau 4 bd Hauterive Pau 64046 France.
Biologie médicale Centre Hospitalier de Pau 4 bd Hauterive Pau 64046 France.
Ann Clin Transl Neurol. 2018 Mar 24;5(5):524-537. doi: 10.1002/acn3.548. eCollection 2018 May.
The low level of passively diffused IgG through the blood-brain barrier is sufficient to blur the estimation of intrathecal IgG synthesis (ITS). Therefore, this estimation requires a mathematical calculation derived from empirical laws, but the range of normal values in healthy controls is wide enough to prevent a precise calculation. This study investigated the precision of various methods of ITS estimations and their application to two clinical situations: plasma exchange and immune suppression targeting ITS.
Based on a mathematical model of ITS, we constructed a population of healthy controls and applied a tunable ITS.
We demonstrate the following results: underestimation of ITS is common at individual level but true ITS is well fitted by cohorts; Q increases after plasma exchange; IgG calculation based on Qlim falsely increases when Q decreases; the sample size required to demonstrate a decrease in ITS increases exponentially with larger Q .
Studies evaluating changes in ITS level should be adjusted to Q . Low amounts of ITS could be largely underestimated.
通过血脑屏障被动扩散的IgG水平较低，足以模糊鞘内IgG合成（ITS）的评估。因此，这种评估需要根据经验法则进行数学计算，但健康对照的正常数值范围足够宽，无法进行精确计算。本研究调查了各种ITS评估方法的准确性及其在两种临床情况中的应用：血浆置换和针对ITS的免疫抑制。
基于ITS的数学模型，我们构建了健康对照人群并应用了可调的ITS。
我们得出以下结果：在个体水平上，ITS被低估很常见，但队列能很好地拟合真实的ITS；血浆置换后Q增加；当Q降低时，基于Qlim的IgG计算错误地增加；证明ITS降低所需的样本量随着Q的增大呈指数增加。
评估ITS水平变化的研究应根据Q进行调整。少量的ITS可能会被大幅低估。
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