Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan.
H.U. Frontier, Inc. (formerly SRL, Inc.), 2-1-1 Nishishinjuku, Shinjuku, Tokyo, Japan.
Microbiol Immunol. 2022 Sep;66(9):418-425. doi: 10.1111/1348-0421.13017. Epub 2022 Jul 18.
High measles-specific antibody titers in the cerebrospinal fluid (CSF) have important diagnostic significance for subacute sclerosing panencephalitis (SSPE), a progressive neurological disorder caused by measles virus variants. However, the diagnostic reference value of antibody levels and the usefulness of the CSF/serum ratio measured using enzyme immunoassays (EIAs) for SSPE diagnosis remain unclear. To facilitate SSPE diagnosis using EIAs, measles immunoglobulin G (IgG) titers in the CSF and serum of patients with and without SSPE were measured and their CSF/serum antibody ratios evaluated. Serum and CSF antibody levels were compared among three patients with SSPE (59 paired samples), 37 non-SSPE patients, and 2618 patients of unknown backgrounds. Of the 59 paired samples from three patients with SSPE, 56 paired samples (94.9%) showed CSF measles IgG levels ≥0.5 IU/mL and a CSF/serum ratio ≥0.05, whereas non-SSPE cases showed CSF measles IgG levels <0.1 IU/mL and a CSF/serum ratio <0.03. Of the 2618 CSF samples with unknown backgrounds, 951 showed measurable IgG levels with EIA, with a CSF/serum ratio peak of 0.005-0.02, with a 90th percentile of 0.05. Assuming the SSPE criteria as CSF measles IgG ≥0.5 IU/mL and a CSF/serum ratio ≥0.05, only 20 samples (0.8%) with unknown backgrounds were categorized as having SSPE. Conversely, assuming the non-SSPE criteria as CSF measles IgG <0.1 IU/mL and a CSF/serum ratio <0.03, 2403 samples (92%) with unknown backgrounds were categorized as not having SSPE. In conclusion, high CSF/serum ratios (≥0.05) and high measles CSF IgG levels (≥0.5 IU/mL) may be useful for diagnosing SSPE.
脑脊液（CSF）中高麻疹特异性抗体滴度对亚急性硬化性全脑炎（SSPE）具有重要的诊断意义，SSPE 是一种由麻疹病毒变异引起的进行性神经障碍。然而，抗体水平的诊断参考值以及使用酶免疫分析（EIA）测量的 CSF/血清比值对 SSPE 诊断的有用性仍不清楚。为了便于使用 EIA 进行 SSPE 诊断，测量了患有和不患有 SSPE 的患者的 CSF 和血清中的麻疹免疫球蛋白 G（IgG）滴度，并评估了其 CSF/血清抗体比值。比较了 3 例 SSPE 患者（59 对样本）、37 例非 SSPE 患者和 2618 例背景未知的患者的血清和 CSF 抗体水平。在 3 例 SSPE 患者的 59 对样本中，56 对样本（94.9%）显示 CSF 麻疹 IgG 水平≥0.5 IU/mL 和 CSF/血清比值≥0.05，而非 SSPE 病例显示 CSF 麻疹 IgG 水平<0.1 IU/mL 和 CSF/血清比值<0.03。在 2618 例背景未知的 CSF 样本中，有 951 例通过 EIA 可测量 IgG 水平，CSF/血清比值峰值为 0.005-0.02，第 90 个百分位数为 0.05。假设 SSPE 标准为 CSF 麻疹 IgG≥0.5 IU/mL 和 CSF/血清比值≥0.05，则仅 20 例（0.8%）背景未知的样本被归类为 SSPE。相反，假设非 SSPE 标准为 CSF 麻疹 IgG<0.1 IU/mL 和 CSF/血清比值<0.03，则 2403 例（92%）背景未知的样本被归类为非 SSPE。总之，高 CSF/血清比值（≥0.05）和高 CSF 麻疹 IgG 水平（≥0.5 IU/mL）可能有助于诊断 SSPE。
