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[脑脊液中寡克隆带与IgG鞘内合成指标及生化标志物联合应用于多发性硬化症的诊断]

[The combined application of oligoclonal bands in cerebrospinal fluid and IgG intrathecal synthesis indicators and biochemical markers in the diagnosis of multiple sclerosis].

作者信息

Chen K L, Jiang J C, Jiang W C, Wang L J, Li S W, Liu Z W, Gu Y Y, Zhang G J

机构信息

Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical Unversity/Beijing Engineering Research Center of Immunological Reagents Clinical Research/NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing 100070, China.

Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100020,China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2024 Aug 6;58(8):1171-1176. doi: 10.3760/cma.j.cn112150-20231212-00433.

Abstract

To establish and verify a diagnostic model for distinguishing multiple sclerosis (MS) from other neurological diseases with similar symptoms by usingcerebrospinal fluid oligoclonal band (CSF-OCB)combined with IgG intrathecal synthesis indicators and biochemical markers. Multiple sclerosis (MS) patients admitted to the Neurology Department of Beijing Tiantan Hospital affiliated with Capital Medical University from January 2014 to December 2022 were selected as the case group, while patients with similar neurological symptoms were selected as the control group. Using the case-control study design, a retrospective analysis was conducted on the detection of age, gender, oligoclonal bands in cerebrospinal fluid, IgG intrathecal synthesis indicators and biochemical indicators for all study subjects. The differential diagnosis model was determined by the multiple logistic regression analysis, and the receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficiency of the differential diagnosis model for neurological diseases with similar symptoms to MS and other conditions. This study included 167 patients in the case group and 335 patients in the control group, of which 128 patients in the case group and 265 patients in the control group were used to construct the model, and 39 patients in the case group and 70 patients in the control group were used for model validation. The differential diagnostic model constructed by a multivariate logistic regression model was Y=0.871×CSF-OCB-0.051×CSFprotein-0.231×CSFchloride+1.183×gender-0.036×LDH+35.770. The model showed that the area under the curve, sensitivity and specificity were respectively 0.916, 87.3% and 87.6%. The Delong test results showed that the diagnostic efficacy of the model was significantly different from OCB, IgG intrathecal synthesis indicators, and OCB combined with IgG intrathecal synthesis indicators (<0.05). The new model validation showed that the actual diagnostic consistency rate for the MS group was 84.6%, while the actual diagnostic consistency rate for the control group was 90.0%. This study combines OCB, IgG intrathecal synthesis indicators, and biochemical indicators to establish a diagnostic prediction model for neurological diseases with similar clinical symptoms in MS. This model may have good differential diagnostic value and can better assist clinical diagnosis in the early stages of disease progression in MS patients.

摘要

通过使用脑脊液寡克隆区带(CSF-OCB)结合IgG鞘内合成指标和生化标志物,建立并验证一种用于区分多发性硬化症(MS)与其他具有相似症状的神经系统疾病的诊断模型。选取2014年1月至2022年12月在首都医科大学附属北京天坛医院神经内科住院的多发性硬化症(MS)患者作为病例组,选取具有相似神经症状的患者作为对照组。采用病例对照研究设计,对所有研究对象的年龄、性别、脑脊液寡克隆区带、IgG鞘内合成指标及生化指标检测进行回顾性分析。通过多元逻辑回归分析确定鉴别诊断模型,采用受试者工作特征(ROC)曲线分析该鉴别诊断模型对与MS症状相似的神经系统疾病及其他病症的诊断效能。本研究病例组167例,对照组335例,其中病例组128例、对照组265例用于构建模型,病例组39例、对照组70例用于模型验证。由多元逻辑回归模型构建的鉴别诊断模型为Y=0.871×CSF-OCB-0.051×CSF蛋白-0.231×CSF氯化物+1.183×性别-0.036×乳酸脱氢酶+35.770。该模型曲线下面积、灵敏度和特异度分别为0.916、87.3%和87.6%。DeLong检验结果显示,该模型的诊断效能与OCB、IgG鞘内合成指标以及OCB联合IgG鞘内合成指标相比有显著差异(<0.05)。新模型验证显示,MS组实际诊断符合率为84.6%,对照组实际诊断符合率为90.0%。本研究结合OCB、IgG鞘内合成指标和生化指标,建立了MS临床症状相似的神经系统疾病诊断预测模型。该模型可能具有良好的鉴别诊断价值,能更好地辅助MS患者疾病进展早期的临床诊断。

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