Zeman A, McLean B, Keir G, Luxton R, Sharief M, Thompson E
Institute of Neurology, London, UK.
J Neurol Neurosurg Psychiatry. 1993 Jan;56(1):32-5. doi: 10.1136/jnnp.56.1.32.
The presence of oligoclonal bands (OCBs) of immunoglobulin G (IgG) in CSF provides evidence for the occurrence of a humoral immune response, but it is not always appreciated that the oligoclonal IgG may have originated in the serum. To determine the diagnostic significance of serum OCBs 146 patients with serum OCBs were identified among 1874 patients with suspected neurological disorders (7.6%). Clear diagnoses had been made in 112 of these patients: in 56 identical CSF and serum bands were present, revealing a systemic immune response, while in 46 additional unique CSF bands indicated that intrathecal IgG synthesis was also occurring. In the first group neoplasia and peripheral neuropathies accounted for over 50% of the diagnoses, infections and systemic inflammatory disorders for 32%, and multiple sclerosis was diagnosed in only one case. These figures contrast considerably with those reported for patients with CSF OCBs alone. Diagnoses in the second group of patients, with unique CSF OCBs in addition to serum OCBs, resembled those among patients with CSF OCBs alone. Examining CSF and serum in parallel for OCBs of IgG provides more diagnostic information than examining CSF alone, and the latter is potentially misleading.
脑脊液中免疫球蛋白G（IgG）寡克隆带（OCBs）的存在为体液免疫反应的发生提供了证据，但人们并不总是认识到寡克隆IgG可能起源于血清。为了确定血清OCBs的诊断意义，在1874例疑似神经系统疾病的患者中确定了146例有血清OCBs（7.6%）。其中112例患者已明确诊断：56例脑脊液和血清中出现相同条带，显示全身免疫反应，而另外46例脑脊液中出现独特条带表明也发生了鞘内IgG合成。在第一组中，肿瘤和周围神经病变占诊断的50%以上，感染和全身性炎症性疾病占32%，仅1例诊断为多发性硬化症。这些数字与仅脑脊液有OCBs的患者报告的数字有很大差异。第二组患者除血清OCBs外还有独特的脑脊液OCBs，其诊断与仅脑脊液有OCBs的患者相似。同时检测脑脊液和血清中的IgG OCBs比仅检测脑脊液能提供更多诊断信息，仅检测脑脊液可能会产生误导。
