KFLC指数在中国队列中可区分多发性硬化症与抗髓鞘少突胶质细胞糖蛋白及水通道蛋白4相关疾病。

KFLC-index distinguishes multiple sclerosis from anti-myelin oligodendrocyte glycoprotein and aquaporin 4 diseases in a Chinese cohort.

作者信息

Tan Hongmei, Deng Xuan, ZhangBao Jingzi, Zhou Lei, Wu Wenqing, Li Haiqing, Li Yuxin, Fan Yuxin, Wang Zhouzhou, Xiao Yiqin, Zhao Chongbo, Guan Ming, Quan Chao, Jiang Haoqin

机构信息

Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.

National Center for Neurological Disorders, Shanghai, People's Republic of China.

出版信息

J Neurol Neurosurg Psychiatry. 2025 Jul 11. doi: 10.1136/jnnp-2025-335953.

DOI:10.1136/jnnp-2025-335953

PMID:40645758

Abstract

BACKGROUND

Kappa free light chain (KFLC) index has emerged as a diagnostic biomarker for multiple sclerosis (MS). This study aims to evaluate the diagnostic accuracy of the KFLC-index in Chinese patients with MS, and its capacity to discriminate MS from myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and neuromyelitis optica spectrum disorders with aquaporin-4 antibody (AQP4+NMOSD).

METHODS

428 patients tested for KFLC-index were enrolled in the study, including 130 patients with MS, 41 with MOGAD, 25 with AQP4+NMOSD, 123 with other inflammatory or infectious neurological disorders (OIND) and 109 with non-inflammatory neurological disorders (NIND). Their oligoclonal band (OCB) results and clinical data were reviewed.

RESULTS

KFLC-index was significantly higher in MS (20.1 (0.9-388.9)) compared with MOGAD (4.8 (0.8-56.1), p=0.003), AQP4+NMOSD (4.5 (1.5-46.4), p=0.011), OIND (2.9 (0.6-238.7), p<0.001) and NIND (1.8 (0.6-110.7), p<0.001). The optimal cut-off value for the KFLC-index to identify MS from the non-selective controls was 8.3, with an accuracy comparable to that of OCB (area under the curve 0.84 vs 0.81, p=0.249). The optimal cut-off values for differentiating MS from MOGAD and AQP4+NMOSD were 18.5 and 12.1, with performance similar to OCB (p=0.756 and 0.064). Combination of KFLC-index and OCB outperformed OCB alone in differentiating MS from non-selective controls and MOGAD (p<0.001 and p=0.044). Female (p=0.009) and higher cerebrospinal fluid leucocyte count (p<0.001) were associated with higher KFLC-index in MS.

CONCLUSION

KFLC-index is a valuable diagnostic tool for differentiating MS from other inflammatory demyelinating diseases.

摘要

背景

κ游离轻链（KFLC）指数已成为多发性硬化症（MS）的一种诊断生物标志物。本研究旨在评估KFLC指数在中国MS患者中的诊断准确性，以及其区分MS与髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）和水通道蛋白4抗体相关视神经脊髓炎谱系障碍（AQP4+NMOSD）的能力。

方法

428例接受KFLC指数检测的患者纳入本研究，包括130例MS患者、41例MOGAD患者、25例AQP4+NMOSD患者、123例其他炎性或感染性神经系统疾病（OIND）患者和109例非炎性神经系统疾病（NIND）患者。回顾了他们的寡克隆带（OCB）结果和临床资料。

结果

MS患者的KFLC指数（20.1（0.9 - 388.9））显著高于MOGAD患者（4.8（0.8 - 56.1），p = 0.003）、AQP4+NMOSD患者（4.5（1.5 - 46.4），p = 0.011）、OIND患者（2.9（0.6 - 238.7），p < 0.001）和NIND患者（1.8（0.6 - 110.7），p < 0.001）。从非选择性对照中识别MS的KFLC指数最佳截断值为8.3，其准确性与OCB相当（曲线下面积分别为0.84和0.81，p = 0.249）。区分MS与MOGAD和AQP4+NMOSD的最佳截断值分别为18.5和12.1，性能与OCB相似（p = 0.756和0.064）。在区分MS与非选择性对照和MOGAD方面，KFLC指数与OCB联合使用优于单独使用OCB（p < 0.001和p = 0.044）。女性（p = 0.009）和较高的脑脊液白细胞计数（p < 0.001）与MS患者较高的KFLC指数相关。