Akaishi Tetsuya, Takahashi Toshiyuki, Fujihara Kazuo, Misu Tatsuro, Nishiyama Shuhei, Takai Yoshiki, Fujimori Juichi, Abe Michiaki, Ishii Tadashi, Aoki Masashi, Nakashima Ichiro
Department of Neurology, Tohoku University School of Medicine, Sendai, Japan; Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.
Department of Neurology, Tohoku University School of Medicine, Sendai, Japan; Department of Neurology, National Hospital Organization Yonezawa National Hospital, Yonezawa, Japan.
Mult Scler Relat Disord. 2020 Oct;45:102382. doi: 10.1016/j.msard.2020.102382. Epub 2020 Jul 7.
The association between routine laboratory findings, including cerebrospinal fluid biomarkers, and neurological outcomes in patients with multiple sclerosis (MS) has not been fully elucidated. In this study, we evaluated blood and cerebrospinal fluid (CSF) analysis results at diagnosis and before treatment in patients with MS and assessed their correlations with neurological outcomes.
In this study, 38 consecutive patients with MS (36 with relapsing-remitting MS and 2 with primary progressive MS) were recruited. Before treatment, all patients underwent routine CSF analysis at the time of diagnosis, including evaluation of albumin and immunoglobulin G (IgG) levels. The association between laboratory data and neurological outcomes was comprehensively evaluated. Subsequent neurological outcome was assessed by using the Expanded Disability Status Scale (EDSS) score at 1 year and 5 years after diagnosis and relapse frequency in the first year and in the first 5 years.
The IgG level in the CSF (rho = 0.46, p = 0.004), oligoclonal band count (rho = 0.61, p = 0.006), ratio of IgG and total protein in CSF (rho = 0.59, p < 0.0001), and ratio of IgG and albumin in CSF (rho = 0.67, p < 0.0001) showed moderate to strong correlations with the subsequent EDSS score 1 year after diagnosis. These variables still showed significant correlations with EDSS 5 years later. Albumin and lactate dehydrogenase levels in CSF did not correlate with the subsequent EDSS score. Relapse frequency did not correlate with any of the studied serum and CSF biomarkers.
IgG levels in CSF at MS diagnosis are significantly correlated with the level of neurological disability independent of the relapse frequency. Markers of intrathecal IgG synthesis, such as the IgG index, are useful in estimating the present and subsequent clinical severity in patients with MS.
包括脑脊液生物标志物在内的常规实验室检查结果与多发性硬化症（MS）患者神经功能结局之间的关联尚未完全阐明。在本研究中，我们评估了MS患者诊断时及治疗前的血液和脑脊液（CSF）分析结果，并评估了它们与神经功能结局的相关性。
本研究招募了38例连续的MS患者（36例复发缓解型MS和2例原发进展型MS）。治疗前，所有患者在诊断时均接受了常规CSF分析，包括白蛋白和免疫球蛋白G（IgG）水平评估。全面评估了实验室数据与神经功能结局之间的关联。通过诊断后1年和5年的扩展残疾状态量表（EDSS）评分以及第一年和前5年的复发频率来评估后续神经功能结局。
CSF中的IgG水平（rho = 0.46，p = 0.004）、寡克隆带计数（rho = 0.61，p = 0.006）、CSF中IgG与总蛋白的比值（rho = 0.59，p < 0.0001）以及CSF中IgG与白蛋白的比值（rho = 0.67，p < 0.0001）与诊断后1年的后续EDSS评分呈中度至强相关性。这些变量在5年后与EDSS仍显示出显著相关性。CSF中的白蛋白和乳酸脱氢酶水平与后续EDSS评分无关。复发频率与所研究的任何血清和CSF生物标志物均无相关性。
MS诊断时CSF中的IgG水平与神经功能残疾程度显著相关，与复发频率无关。鞘内IgG合成标志物，如IgG指数，有助于评估MS患者当前及后续的临床严重程度。
