Berek Klaus, Schmidauer Martin, Auer Michael, Bsteh Gabriel, Zinganell Anne, Deisenhammer Florian, Di Pauli Franziska, Hegen Harald
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Eur J Neurol. 2025 Aug;32(8):e70323. doi: 10.1111/ene.70323.
The diagnosis of Varicella-zoster virus related neurological disease (VZD) and Lyme neuroborreliosis (LNB) is based on clinical presentation as well as cerebrospinal fluid (CSF) results.
To evaluate and compare the diagnostic utility of oligoclonal bands (OCB) and the κ-free light chain (FLC) index in patients with VZD and LNB.
Patients with the diagnosis of VZD or LNB at the Department of Neurology of the Medical University of Innsbruck between 2008 to 2020 were included. OCB were determined by isoelectric focusing followed by immunoblotting, κ-FLC were measured by immunonephelometry.
A total of 82 patients were included in the study comprising 48 patients with VZD and 34 with LNB. LNB patients exhibited higher κ-FLC indices (29 [14-45] vs. 4 [2-12], p < 0.001) and were more frequently OCB positive (65% vs. 8%, p < 0.001) than VZD patients. The disease duration was longer in OCB-positive patients (VZD: 21 [18-28] days; LNB: 15 [7-22] days) compared to OCB-negative patients (VZD: 10 [5-17] days, p = 0.030; LNB: 5 [4-7] days, p = 0.006). No differences in disease duration were observed between patients with positive or negative κ-FLC index. In multivariable analysis, OCB positivity was associated with disease duration (Odds Ratio [OR]: 1.11, 95% confidence interval: 1.01-1.23, p = 0.028), while κ-FLC index was not.
In both VZD and LNB, the κ-FLC index was more frequently positive than OCB, particularly in cases with shorter disease duration. This suggests that the κ-FLC index may be a more sensitive marker of (sub)acute intrathecal inflammation.
水痘带状疱疹病毒相关神经系统疾病(VZD)和莱姆病神经螺旋体病(LNB)的诊断基于临床表现以及脑脊液(CSF)检查结果。
评估和比较寡克隆区带(OCB)和κ游离轻链(FLC)指数在VZD和LNB患者中的诊断效用。
纳入2008年至2020年在因斯布鲁克医科大学神经病学系诊断为VZD或LNB的患者。OCB通过等电聚焦后免疫印迹法测定,κ-FLC通过免疫比浊法测量。
本研究共纳入82例患者,其中48例VZD患者,34例LNB患者。LNB患者的κ-FLC指数更高(29[14 - 45]对4[2 - 12],p < 0.001),且OCB阳性率高于VZD患者(65%对8%,p < 0.001)。与OCB阴性患者相比,OCB阳性患者的病程更长(VZD:21[18 - 28]天;LNB:15[7 - 22]天)(VZD:OCB阴性患者为10[5 - 17]天,p = 0.030;LNB:OCB阴性患者为5[4 - 7]天,p = 0.006)。κ-FLC指数阳性或阴性患者之间未观察到病程差异。在多变量分析中,OCB阳性与病程相关(优势比[OR]:1.11,95%置信区间:1.01 - 1.23,p = 0.028),而κ-FLC指数与病程无关。
在VZD和LNB中,κ-FLC指数阳性率均高于OCB,尤其是在病程较短的病例中。这表明κ-FLC指数可能是(亚)急性鞘内炎症更敏感的标志物。