Andersson M, Alvarez-Cermeño J, Bernardi G, Cogato I, Fredman P, Frederiksen J, Fredrikson S, Gallo P, Grimaldi L M, Grønning M
Sahlgrenska Hospital, Gothenburg, Sweden.
J Neurol Neurosurg Psychiatry. 1994 Aug;57(8):897-902. doi: 10.1136/jnnp.57.8.897.
The Committee of the European Concerted Action for Multiple Sclerosis (Charcot Foundation) organised five workshops to discuss CSF analytical standards in the diagnosis of multiple sclerosis. This consensus report from 12 European countries summarises the results of those workshops. It is hoped that neurologists will confer with their colleagues in clinical chemistry to arrange the best possible local practice. The most sensitive method for the detection of oligoclonal immunoglobulin bands is isoelectric focusing. The same amounts of IgG in parallel CSF and serum samples are used and oligoclonal bands are revealed with IgG specific antibody staining. All laboratories performing isoelectric focusing should check their technique at least annually using "blind" standards for the five different CSF and serum patterns. Quantitative measurements of IgG production in the CNS are less sensitive than isoelectric focusing. The preferred method for detection of blood-CSF barrier dysfunction is the albumin quotient. The CSF albumin or total protein concentrations are less satisfactory. These results must be interpreted with reference to the age of the patient and the local method of determination. Cells should be counted. The normal value is no more than 4 cells/microliters. Among evolving optional tests, measurement of the combined local synthesis of antibodies against measles, rubella, and/or varicella zoster could represent a significant advance if it offers higher specificity (not sensitivity) for identifying chronic rather than acute inflammation. Other tests that may have useful correlations with clinical indices include those for oligoclonal free light chains, IgM, IgA, or myelin basic protein concentrations.
欧洲多发性硬化症协调行动委员会（夏科基金会）组织了五场研讨会，以讨论多发性硬化症诊断中的脑脊液分析标准。这份来自12个欧洲国家的共识报告总结了这些研讨会的成果。希望神经科医生能与临床化学领域的同事协商，安排尽可能最佳的本地实践。检测寡克隆免疫球蛋白带最敏感的方法是等电聚焦。使用等量的平行脑脊液和血清样本中的IgG，并用IgG特异性抗体染色显示寡克隆带。所有进行等电聚焦的实验室应至少每年使用针对五种不同脑脊液和血清模式的“盲法”标准检查其技术。中枢神经系统中IgG产生的定量测量不如等电聚焦敏感。检测血脑屏障功能障碍的首选方法是白蛋白商。脑脊液白蛋白或总蛋白浓度不太令人满意。这些结果必须结合患者年龄和当地测定方法进行解释。应进行细胞计数。正常值不超过4个细胞/微升。在不断发展的可选检测中，如果针对麻疹、风疹和/或水痘带状疱疹的抗体联合局部合成测量对识别慢性而非急性炎症具有更高的特异性（而非敏感性），则可能代表一项重大进展。其他可能与临床指标有有用关联的检测包括寡克隆游离轻链、IgM、IgA或髓鞘碱性蛋白浓度的检测。
