Trojano M, Avolio C, Simone I L, Defazio G, Manzari C, De Robertis F, Calò A, Livrea P
Institute of Clinical Neurology, University of Bari, Italy.
Neurology. 1996 Dec;47(6):1535-41. doi: 10.1212/wnl.47.6.1535.
We measured soluble intercellular adhesion molecule-1 (sICAM-1) in the serum and cerebrospinal fluid (CSF) of 35 clinically active relapsing-remitting (RR) multiple sclerosis (MS) patients who underwent both lumbar puncture and gadopentetate dimeglumine (Gd-DTPA)-enhanced MRI within an interval of 1 week, and of 30 neurological controls of whom 17 had noninflammatory neurologic diseases (NIND), 8 bacterial meningitis (BM), and 5 AIDS dementia complex (ADC). Thirteen of the MS patients assumed corticosteroids at the time of the study. While sICAM-1 serum levels were highest in the BM group (p < 0.005), untreated MS patients showed levels higher (p < 0.05) than treated MS and NIND, but similar to ADC. Moreover, the untreated MS group had CSF/serum sICAM-1:CSF/serum albumin (sICAM-1 index) values higher than the treated group (p < 0.01), NIND (p < 0.005), and BM (p < 0.05); high sICAM-1 index was found also in ADC. Untreated MS patients with one or more Gd-DTPA-enhancing MRI lesions (Gd-positive) had higher mean values of CSF/serum albumin ratio (QAlbumin) and CSF mononuclear cells compared to patients without such lesions (Gd-negative). In the untreated Gd-negative patients, sICAM-1 serum levels were higher (p < 0.05) than those in Gd-positive patients. In the latter group, there were positive correlations between the number of CSF mononuclear cells and both IgG (p < 0.01) and sICAM-1 indices (p < 0.05), between QAlbumin and QsICAM-1 (p < 0.005) and between Qalbumin and the Expanded Disability Status Scale score (p = 0.05). There were no significant correlations in the Gd-negative group. These results suggest that sICAM-1 index can be a better marker of intrathecal sICAM-1 synthesis than CSF levels and provide additional insights, in vivo, into the blood-brain barrier mechanisms underlying MRI Gd-enhancement in clinically active RR MS.
我们检测了35例临床活动期复发缓解型（RR）多发性硬化（MS）患者血清和脑脊液（CSF）中的可溶性细胞间黏附分子-1（sICAM-1），这些患者在1周内同时接受了腰椎穿刺和钆喷酸葡胺（Gd-DTPA）增强MRI检查，还检测了30例神经科对照者的sICAM-1，其中17例患有非炎性神经系统疾病（NIND），8例患有细菌性脑膜炎（BM），5例患有艾滋病痴呆综合征（ADC）。13例MS患者在研究时使用了皮质类固醇。虽然BM组的sICAM-1血清水平最高（p<0.005），但未治疗的MS患者的水平高于接受治疗的MS患者和NIND患者（p<0.05），但与ADC患者相似。此外，未治疗的MS组的脑脊液/血清sICAM-1:脑脊液/血清白蛋白（sICAM-1指数）值高于治疗组（p<0.01）、NIND组（p<0.005）和BM组（p<0.05）；ADC组也发现sICAM-1指数较高。与无此类病变（Gd阴性）的患者相比，有一个或多个Gd-DTPA增强MRI病变（Gd阳性）的未治疗MS患者的脑脊液/血清白蛋白比值（QAlbumin）和脑脊液单核细胞的平均值更高。在未治疗的Gd阴性患者中，sICAM-1血清水平高于Gd阳性患者（p<0.05）。在后者组中，脑脊液单核细胞数量与IgG（p<0.01）和sICAM-1指数（p<0.05）、QAlbumin与QsICAM-1（p<0.005）以及QAlbumin与扩展残疾状态量表评分（p=0.05）之间存在正相关。Gd阴性组无显著相关性。这些结果表明，sICAM-1指数可能是比脑脊液水平更好的鞘内sICAM-1合成标志物，并在体内为临床活动期RR MS中MRI Gd增强背后的血脑屏障机制提供了更多见解。
