Tian Jingluan, Liu Xiaoni, Li Yarong, Gu Yuehua, Deng Bo, Yang Wenbo, Yu Hai, Zhang Xiang, Chen Xiangjun
Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, National Center for Neurological Disorders, Shanghai, China; Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, National Center for Neurological Disorders, Shanghai, China.
Clin Chim Acta. 2025 Mar 1;569:120145. doi: 10.1016/j.cca.2025.120145. Epub 2025 Jan 19.
CSF (cerebrospinal fluid) oligoclonal immunoglobulin G bands (IgG-OCBs) analysis plays a crucial role in diagnosis of various neurological disorders. However, the clinical significance of mirror pattern bands remains unclear, and their precise application is not well understood.
We retrospectively reviewed a total of 7597 IgG-OCB records detected using isoelectric focusing from May 2020 and August 2023 at Huashan Hospital. Among these, 121 mirror pattern bands (62 type IV and 59 type V) were identified in patients with neurological disorders. Basic clinical data, including discharge diagnosis, gender, and age, were collected. Additionally, CSF and serum immunological parameters, as well as monoclonal protein (M protein) detection, were reviewed.
Although mirror pattern bands are rarely observed in neurological diseases, approximately half of these patterns were found in patients with peripheral neuropathy (PN). In the type IV group, 40.74 % of cases were associated with immune-mediated PN, while type V pattern was predominantly observed in cancer-related/lymphoproliferative PN, comprising 63.33 % of the cases. Patients with cancer-related or lymphoproliferative PN showed significantly higher IgG-CSF concentrations (p = 0.017) and 24-h intrathecal IgG synthesis rate (p = 0.022), indicating a stronger humoral immune response. Additionally, both patients with immune-mediated PN and cancer-related/lymphoproliferative PN exhibited abnormal intrathecal synthesis rate and moderate to severe blood-brain barrier impairment. Furthermore, the type V group also exhibited a high prevalence of M protein positivity.
The differential immunological responses and distinct patterns of OCBs observed in our study underscore the critical role of OCB analysis in the diagnostic workup of PN.
脑脊液（CSF）寡克隆免疫球蛋白G带（IgG-OCBs）分析在各种神经系统疾病的诊断中起着至关重要的作用。然而，镜像模式带的临床意义仍不清楚，其确切应用也未得到充分理解。
我们回顾性分析了2020年5月至2023年8月在华山医院使用等电聚焦检测的7597条IgG-OCB记录。其中，在神经系统疾病患者中识别出121条镜像模式带（62条IV型和59条V型）。收集了基本临床数据，包括出院诊断、性别和年龄。此外，还回顾了脑脊液和血清免疫学参数以及单克隆蛋白（M蛋白）检测结果。
虽然镜像模式带在神经系统疾病中很少见，但约一半的此类模式出现在周围神经病（PN）患者中。在IV型组中，40.74%的病例与免疫介导的PN相关，而V型模式主要见于癌症相关/淋巴增殖性PN，占病例的63.33%。癌症相关或淋巴增殖性PN患者的IgG-CSF浓度（p = 0.017）和24小时鞘内IgG合成率（p = 0.022）显著更高，表明体液免疫反应更强。此外，免疫介导的PN患者和癌症相关/淋巴增殖性PN患者均表现出鞘内合成率异常和中度至重度血脑屏障损伤。此外，V型组M蛋白阳性率也很高。
我们的研究中观察到的OCBs不同免疫反应和独特模式强调了OCB分析在PN诊断检查中的关键作用。
