Translational Neuroimmunology Group, Kids Neuroscience Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Department of Neurology, Concord Hospital, Sydney, Australia.
Ann Clin Transl Neurol. 2024 Sep;11(9):2514-2519. doi: 10.1002/acn3.52163. Epub 2024 Jul 28.
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is diagnosed by serum MOG-immunoglobulin G (MOG-IgG) in association with typical demyelination. 111/1127 patients with paired CSF/serum samples were seropositive for MOG-IgG. Only 7/1016 (0.7%) seronegative patients had CSF-restricted MOG-IgG. While 3/7 patients had longitudinally extensive transverse myelitis, four had a confirmed alternate diagnosis (three multiple sclerosis, one CNS vasculitis). In a national referral setting, CSF-restricted MOG-IgG had a low sensitivity (2.63%, 95%CI 0.55-7.50%) and low positive predictive value (1.97%, 95%CI 0.45-8.13%). We strongly recommend serum as the preferred diagnostic biospecimen, and urge caution in the interpretation of CSF-restricted MOG-IgG in patients without clinico-radiological features consistent with MOGAD.
髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）通过血清髓鞘少突胶质细胞糖蛋白免疫球蛋白 G（MOG-IgG）与典型脱髓鞘相关联进行诊断。111/1127 例配对 CSF/血清样本的患者 MOG-IgG 血清阳性。仅 1016 例（0.7%）血清阴性患者的 CSF 中存在 MOG-IgG 限制。虽然 3/7 例患者患有纵向广泛横贯性脊髓炎，但 4 例患者有明确的其他诊断（3 例多发性硬化症，1 例中枢神经系统血管炎）。在全国转诊环境中，CSF 限制的 MOG-IgG 敏感性低（2.63%，95%CI 0.55-7.50%），阳性预测值低（1.97%，95%CI 0.45-8.13%）。我们强烈建议使用血清作为首选诊断生物样本，并在没有与 MOGAD 一致的临床放射学特征的患者中对 CSF 限制的 MOG-IgG 的解释保持谨慎。
