Simonsen Cecilia Smith, Flemmen Heidi Øyen, Lauritzen Trine, Berg-Hansen Pål, Moen Stine Marit, Celius Elisabeth Gulowsen
Department of Neurology, Vestre Viken Hospital Trust, Norway.
Department of Neurology, Hospital Telemark HF, Norway.
Mult Scler J Exp Transl Clin. 2020 Jan 22;6(1):2055217319901291. doi: 10.1177/2055217319901291. eCollection 2020 Jan-Mar.
Diagnostic criteria for multiple sclerosis have been developed to guide the diagnostic process. In the latest revision of the McDonald criteria, the presence of oligoclonal bands may replace the need for dissemination in time. The aim of this study is to investigate if the less time-consuming analysis of immunoglobulin G index in cerebrospinal fluid can safely predict the findings of oligoclonal bands.
This is a retrospective study of patients with multiple sclerosis at three hospitals in South-East Norway where lumbar puncture is performed routinely. We included patients diagnosed with multiple sclerosis after 2005 with known oligoclonal band status and an immunoglobulin G index score.
Of 1295 patients diagnosed during or after 2005, 93.8% were oligoclonal band positive at diagnosis. Of 842 multiple sclerosis patients with known immunoglobulin G index and oligoclonal band status, 93.3% were oligoclonal band positive and 76.7% had an elevated immunoglobulin G index. The positive predictive value of a high immunoglobulin G index when oligoclonal bands are positive was 99.4% (95% confidence interval 98.4-99.8%). The negative predictive value of a normal immunoglobulin G index when oligoclonal bands are negative was 26.5% (95% confidence interval 23.5-29.9%).
An immunoglobulin G index >0.7 has a positive predictive value >99% for oligoclonal bands. An elevated immunoglobulin G index adds diagnostic value versus oligoclonal bands and saves time in the diagnostic process.
已制定多发性硬化症的诊断标准以指导诊断过程。在麦克唐纳标准的最新修订版中，寡克隆带的存在可能取代对时间上播散的需求。本研究的目的是调查脑脊液中免疫球蛋白G指数耗时较短的分析是否能够安全地预测寡克隆带的结果。
这是一项对挪威东南部三家医院的多发性硬化症患者进行的回顾性研究，这些医院常规进行腰椎穿刺。我们纳入了2005年以后诊断为多发性硬化症且已知寡克隆带状态和免疫球蛋白G指数评分的患者。
在2005年期间或之后诊断的1295例患者中，93.8%在诊断时寡克隆带呈阳性。在842例已知免疫球蛋白G指数和寡克隆带状态的多发性硬化症患者中，93.3%寡克隆带呈阳性，76.7%免疫球蛋白G指数升高。当寡克隆带呈阳性时，高免疫球蛋白G指数的阳性预测值为99.4%（95%置信区间98.4 - 99.8%）。当寡克隆带呈阴性时，正常免疫球蛋白G指数的阴性预测值为26.5%（95%置信区间23.5 - 29.9%）。
免疫球蛋白G指数>0.7对寡克隆带的阳性预测值>99%。与寡克隆带相比，免疫球蛋白G指数升高增加了诊断价值，并在诊断过程中节省了时间。
