Hanna P A, Jankovic J
Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
Neurology. 1998 Jun;50(6):1624-9. doi: 10.1212/wnl.50.6.1624.
To compare the mouse protection bioassay (MPB) to the Western blot assay (WBA) in detecting antibodies against botulinum toxin A (BTX-A) and to correlate the assay results with clinical responses to BTX-A injections.
MPB and WBA assay results were compared in 51 patients (34 nonresponders and 17 responders) who received BTX-A injections, most commonly for cervical dystonia. A subset of patients received a "test" injection into either the right eyebrow (14) or right frontalis (12).
Twelve patients with antibodies against BTX-A (Ab+) detected by WBA did not demonstrate antibodies (Ab-) by MPB. Conversely, five patients were Ab+ by MPB but Ab- by WBA. Specificity of the MPB was 100% on all three parameters (clinical, eyebrow, and frontalis injections), whereas WBA specificity was only 71% for clinical response but 100% for both eyebrow and frontalis responses. Sensitivities for both assays were low (33 to 53%). Of the 16 patients previously Ab+ by MPB, seven became negative on retesting after a mean interval of 33 months (range, 6 to 93 months).
The lower specificity of the WBA compared to the MPB suggests that the WBA detects nonblocking antibodies. Eyebrow and frontalis "test" injections correlated well with MPB and WBA results and with clinical responses and may be useful in the evaluation of BTX nonresponders.
比较小鼠保护生物测定法（MPB）和蛋白质印迹法（WBA）在检测抗A型肉毒毒素（BTX-A）抗体方面的差异，并将检测结果与BTX-A注射的临床反应相关联。
对51例接受BTX-A注射（最常见于治疗颈部肌张力障碍）的患者（34例无反应者和17例有反应者）的MPB和WBA检测结果进行比较。一部分患者在右眉（14例）或右额肌（12例）接受了“试验性”注射。
通过WBA检测出抗BTX-A抗体（Ab+）的12例患者，MPB检测显示无抗体（Ab-）。相反，5例患者MPB检测为Ab+，但WBA检测为Ab-。MPB在所有三个参数（临床、眉部和额肌注射）上的特异性均为100%，而WBA对临床反应的特异性仅为71%，但对眉部和额肌反应的特异性为100%。两种检测方法的敏感性均较低（33%至53%）。在之前MPB检测为Ab+的16例患者中，7例在平均间隔33个月（范围6至93个月）后重新检测时转为阴性。
与MPB相比，WBA的特异性较低，提示WBA检测到的是非阻断性抗体。眉部和额肌“试验性”注射与MPB和WBA结果以及临床反应相关性良好，可能有助于评估BTX无反应者。
