κFLC 指数在多发性硬化症诊断中的动态解读：视角的转变。
A dynamic interpretation of κFLC index for the diagnosis of multiple sclerosis: a change of perspective.
机构信息
Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123, Catania, Italy.
Multiple Sclerosis Unit, University-Hospital G. Rodolico-San Marco, Via Santa Sofia 78, 95123, Catania, Italy.
出版信息
J Neurol. 2023 Dec;270(12):6010-6020. doi: 10.1007/s00415-023-11952-3. Epub 2023 Aug 28.
BACKGROUND
Previous studies attempted to define the best threshold for κ free light chains (κFLC) index, confirming higher sensitivity (Se) but less specificity (Sp) compared with IgG oligoclonal bands (OCB) for the diagnosis of MS.
OBJECTIVE
To evaluate the diagnostic accuracy of different κFLC index intervals in a miscellaneous cohort of neurological patients, proposing a procedural flowchart for MS diagnosis.
METHODS
We analyzed data from 607 patients diagnosed with MS (179), CIS (116), other inflammatory (94) or non-inflammatory neurological diseases (218). Measures of diagnostic accuracy were reported for different potential thresholds of κFLC index, and for IgG OCB and IgG index. Binary logistic regression was to used to calculate the odds of being diagnosed with MS based on each increase of κFLC index.
RESULTS
CSF IgG OCB showed 72.2% Se (CI 95% 68.4-75.7) and 95.2% Sp (CI 95% 93.1-96.7) in discriminating between MS/CIS and controls, with an AUC of 0.84 (CI 95% 0.80-0.87). The highest diagnostic accuracy was reported for κFLC index cut-off of 5.0 (Se = 85.4%, Sp = 90.4%, AUC = 0.88), while a threshold of 11.0 exhibited higher Sp (95.5%, 95% CI 93.1-97.1) than IgG OCB. AUCs for all thresholds between 4.25 and 6.6 were not significantly different from each other, but were significantly higher than the AUC of IgG OCB (p < 0.05). The odds of being diagnosed with MS/CIS increased by 17.1% for each unit increase of κFLC index (OR = 1.17; 95% CI 1.12-1.23; p < 0.001).
CONCLUSION
κFLC index performed better than CSF IgG OCB in supporting the diagnosis of MS/CIS, with the advantage of being a cost-effective and quantitative analysis.
背景
先前的研究试图确定κ 游离轻链（κFLC）指数的最佳阈值，证实其对多发性硬化症（MS）的诊断具有较高的敏感性（Se），但特异性（Sp）较低。
目的
评估不同 κFLC 指数区间在神经科患者混杂队列中的诊断准确性，提出 MS 诊断的程序流程图。
方法
我们分析了 607 例诊断为 MS（179 例）、CIS（116 例）、其他炎症性（94 例）或非炎症性神经疾病（218 例）患者的数据。报告了不同潜在 κFLC 指数阈值的诊断准确性测量值，并报告了 IgG 寡克隆带（OCB）和 IgG 指数的测量值。二元逻辑回归用于计算基于每个 κFLC 指数增加而被诊断为 MS 的几率。
结果
CSF IgG OCB 区分 MS/CIS 与对照组的 Se 为 72.2%（95%CI 95% 68.4-75.7），Sp 为 95.2%（95%CI 93.1-96.7），AUC 为 0.84（95%CI 95% 0.80-0.87）。κFLC 指数截断值为 5.0 时，诊断准确性最高（Se = 85.4%，Sp = 90.4%，AUC = 0.88），而截断值为 11.0 时，Sp （95.5%，95%CI 93.1-97.1）高于 IgG OCB。4.25 至 6.6 之间所有阈值的 AUC 彼此之间无显著差异，但均显著高于 IgG OCB 的 AUC（p < 0.05）。κFLC 指数每增加 1 单位，诊断为 MS/CIS 的几率增加 17.1%（OR = 1.17；95%CI 1.12-1.23；p < 0.001）。
结论
κFLC 指数在支持 MS/CIS 的诊断方面优于 CSF IgG OCB，具有成本效益和定量分析的优势。
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