IgG指数和寡克隆带在神经科医院患者群体中对多发性硬化症的诊断作用。

IF 2.1 4区医学 Q3 MEDICAL LABORATORY TECHNOLOGY

Annals of Clinical Biochemistry Pub Date : 2023-09-01 Epub Date: 2023-06-05 DOI:10.1177/00045632231179618

Francesca Shaw, Carrie Chadwick

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引用次数: 0

摘要

背景：多发性硬化症（MS）是一种中枢神经系统的慢性脱髓鞘疾病。诊断基于2017年修订的麦当劳标准。CSF中不匹配的寡克隆带（OCB）（即阳性OCB）可以通过磁共振成像（MRI）及时替代传播。Simonsen等人（2020）声称，免疫球蛋白G（IgG）指数的升高（＞0.7）可以取代OCB状态。本研究旨在确定IgG指数在沃尔顿中心NHS基金会信托基金会（WCFT）（一家神经病学和神经外科医院）服务的人群中对多发性硬化症的诊断效用，并得出基于人群的IgG指数参考区间。方法：对2018年11月至2021年实验室信息系统（LIS）的OCB结果进行整理。从电子病历中获得最终诊断和用药史。根据年龄进行排除（结果：1101个结果中有935个在排除后仍然存在。226个（24.2%）诊断为MS，212个（93.8%）OCB阳性，165个（73.0%）IgG指数升高。IgG指数升高的诊断特异性为90.3%，而OCB阳性的诊断特异度为86.9%。386个OCB阴性结果用于建立第95个百分位数的IgG指数参考区间（0.36-0.68）。结论：本研究提供的证据表明，在诊断MS时，IgG指数不应取代OCB。>0.7是确定患者群体IgG指数升高的合适界限。

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The diagnostic utility of IgG index and oligoclonal bands for multiple sclerosis in a neurology hospital patient population.

Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. Diagnosis is based on the 2017 revised McDonald criteria. Unmatched oligoclonal bands (OCB) within the CSF (i.e. positive OCB) can substitute for dissemination in time by magnetic resonance imaging (MRI). Simonsen et al. (2020) claimed a raised (>0.7) immunoglobulin G (IgG) index could replace OCB status. This study aimed to establish the diagnostic utility of IgG index for MS in the population served by The Walton Centre NHS Foundation Trust (WCFT) a neurology and neurosurgery hospital, and to derive a population-based IgG index reference interval.

Methods: OCB results from the laboratory information system (LIS) were collated from November 2018 to 2021. Final diagnosis and medication history was obtained from the electronic patient record. Exclusions were made based on age (<18 years) at the time of lumbar puncture (LP) disease-modifying treatment prior to LP, unknown IgG index and unclear OCB patterns.

Results: 935 of 1101 results remained following exclusions. 226 (24.2%) had a diagnosis of MS, 212 (93.8%) were OCB positive and 165 (73.0%) had a raised IgG index. The diagnostic specificity of a raised IgG index was calculated at 90.3% compared to 86.9% for positive OCB. 386 results with negative OCB were used to establish the IgG index reference interval (0.36-0.68) at 95th percentiles.

Conclusion: This study provides evidence that IgG index should not replace OCB in the diagnosis of MS. >0.7 is an appropriate cut-off to define a raised IgG index for the patient population.

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来源期刊

Annals of Clinical Biochemistry Biochemistry, Genetics and Molecular Biology-Clinical Biochemistry

CiteScore

5.20

自引率

4.50%

发文量

期刊介绍： Annals of Clinical Biochemistry is the fully peer reviewed international journal of the Association for Clinical Biochemistry and Laboratory Medicine. Annals of Clinical Biochemistry accepts papers that contribute to knowledge in all fields of laboratory medicine, especially those pertaining to the understanding, diagnosis and treatment of human disease. It publishes papers on clinical biochemistry, clinical audit, metabolic medicine, immunology, genetics, biotechnology, haematology, microbiology, computing and management where they have both biochemical and clinical relevance. Papers describing evaluation or implementation of commercial reagent kits or the performance of new analysers require substantial original information. Unless of exceptional interest and novelty, studies dealing with the redox status in various diseases are not generally considered within the journal''s scope. Studies documenting the association of single nucleotide polymorphisms (SNPs) with particular phenotypes will not normally be considered, given the greater strength of genome wide association studies (GWAS). Research undertaken in non-human animals will not be considered for publication in the Annals. Annals of Clinical Biochemistry is also the official journal of NVKC (de Nederlandse Vereniging voor Klinische Chemie) and JSCC (Japan Society of Clinical Chemistry).