Neurology Unit, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Clinical Biochemistry, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Mult Scler Relat Disord. 2019 May;30:81-84. doi: 10.1016/j.msard.2019.02.001. Epub 2019 Feb 5.
Cerebrospinal fluid (CSF) kappa free light chains (KFLC) have been suggested as quantitative alternative to oligoclonal bands (OB) in multiple sclerosis (MS) diagnosis. Despite OB have been associated to poor disease prognosis, little is known on KFLC in predicting MS early progression. Our aim is to evaluate the prognostic value of KFLC in a cohort of Italian MS patients.
100 patients (64 females) underwent CSF analysis during their diagnostic MS work-up. We collected clinical/paraclinical features (gender, age at onset, clinical course, early MS treatments (within 1 year), gadolinium-enhancing (Gd+) lesions), calculated K index (ratio CSF-serum KFLC and albumin), and MS severity score (MSSS) at last follow up (minimum 1 year). Statistical analysis included Mann-Whitney descriptive analysis, Spearman correlation for independent samples, and linear regression for significant predictors.
K index resulted a significant predictor for disability over time being higher in patients who developed greater MSSS. Accordingly, K index was also significantly increased in patients undergoing early versus delayed treatment (N = 50/100, p = 0.046). A similar role in predicting MS disability was confirmed for age at onset. No other factors were retained in our regression model. Of note, K index was not associated to known MS prognostic markers such as gender, age at onset, and Gd+ lesions (N = 31/96).
Our study suggests KFLC as a CSF quantitative marker to predict early disability in MS (despite not being a substitute for OB).
脑脊液（CSF）游离轻链 kappa（KFLC）已被提议作为多发性硬化症（MS）诊断中寡克隆带（OB）的定量替代物。尽管 OB 与疾病预后不良有关，但对于 KFLC 在预测 MS 早期进展中的作用知之甚少。我们的目的是评估 CSF KFLC 在意大利 MS 患者队列中的预后价值。
100 例患者（64 名女性）在诊断性 MS 检查期间接受了 CSF 分析。我们收集了临床/临床前特征（性别、发病年龄、临床病程、早期 MS 治疗（1 年内）、钆增强（Gd+）病变），计算了 K 指数（CSF-血清 KFLC 和白蛋白的比值）和最后一次随访时的 MS 严重程度评分（MSSS）（至少 1 年）。统计分析包括 Mann-Whitney 描述性分析、独立样本 Spearman 相关性分析和显著预测因子的线性回归。
K 指数是时间推移中残疾的显著预测因子，在发生更大 MSSS 的患者中更高。因此，在早期与延迟治疗的患者中（N=100/50，p=0.046），K 指数也显著增加。在预测 MS 残疾方面，发病年龄也起到了类似的作用。我们的回归模型中没有保留其他因素。值得注意的是，K 指数与已知的 MS 预后标志物如性别、发病年龄和 Gd+病变无关（N=96/31）。
我们的研究表明，KFLC 可作为 CSF 定量标志物，预测 MS 的早期残疾（尽管不能替代 OB）。
