FLOW-RATE OF CEREBROSPINAL-FLUID (CSF) - A CONCEPT COMMON TO NORMAL BLOOD-CSF BARRIER FUNCTION AND TO DYSFUNCTION IN NEUROLOGICAL DISEASES
FLOW-RATE OF CEREBROSPINAL-FLUID (CSF) - A CONCEPT COMMON TO NORMAL BLOOD-CSF BARRIER FUNCTION AND TO DYSFUNCTION IN NEUROLOGICAL DISEASES
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DOI：
10.1016/0022-510x(94)90298-4
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发表时间：
1994-04-01
影响因子：
4.4
通讯作者：
REIBER, H
中科院分区：
文献类型：
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作者：
REIBER, H
许多神经系统疾病伴有脑脊液（CSF）中蛋白质浓度升高，称为血-CSF屏障功能障碍。早期对血清蛋白血-CSF屏障“泄漏”的解释可以通过引入CSF/血清IgG、伊加和IgM商的“群体变异系数”（DELTAQ/QBAR）来修改，该系数作为白蛋白商增加的函数进行评估（Q（Alb））。这里提供的数据是基于4380例神经系统患者的标本。发现这些群体变异系数在正常和病理CSF蛋白浓度的两个数量级上是恒定的（Q（Alb）= 1.6）。（10（-3）150 . 10（-3））。这种恒定性表明，在从血液到CSF的扩散控制蛋白质转移方面，血液-CSF屏障相关结构没有变化，因此分子大小依赖性选择性没有变化。神经系统疾病中CSF中血浆蛋白浓度的病理性增加也可以通过CSF流速的降低来定量解释，这是由于其对CSF蛋白浓度的双功能影响：体积交换减少，以及如新陈述的，增加了进入CSF的分子净通量而不改变渗透系数。同样，基于变化的CSF流速，经验地描述不同大小的蛋白质之间的商比（例如Q（IgG）：Q（Alb））随着CSF蛋白质含量（Q（Alb））的增加而变化的双曲线函数同样可以从扩散定律中推导出作为生理相关描述。CSF诊断商图中CSF中脑源性和血源性蛋白质组分之间的双曲线判别线可在大量病例研究的基础上进一步改进。其他生理和病理方面，如正常新生儿、脊髓阻滞、脑膜炎性过程、CNS白血病或多发性神经根炎以及动物种属依赖性变异中的高CSF蛋白值，均可解释为CSF流速的差异或变化。
Many neurological diseases are accompanied by increased protein concentrations in the cerebrospinal fluid (CSF), described as a blood-CSF barrier dysfunction. The earlier interpretation as a ''leakage'' of the blood-CSF barrier for serum proteins could be revised by introduction of a ''population variation coefficient'' of the CSF/serum quotients for IgG, IgA and IgM (DELTAQ/QBAR) which is evaluated as a function of increasing albumin quotients (Q(Alb)). The data presented here are based on specimens from 4380 neurological patients. These population variation coefficients were found to be constant over two orders of magnitude of normal and pathological CSF protein concentrations (Q(Alb) = 1.6 . (10(-3) 150 . 10(-3)). This constancy indicates that there was no change in blood-CSF barrier related structures with respect to diffusion controlled protein transfer from blood into CSF and hence no change in molecular size dependent selectivity. The pathological increase of plasma protein concentrations in CSF in neurological diseases could also be explained quantitatively by a decrease of CSF flow rate due to its bifunctional influence on CSF protein concentration: reduced volume exchange, and as newly stated, increased molecular net flux into CSF without change of permeability coefficients. Again, on the basis of a changing CSF flow rate, the hyperbolic functions, which describe empirically the changing quotient ratios between proteins of different size (e.g. Q(IgG) : Q(Alb)) With increasing CSF protein content (Q(Alb)) can likewise be derived from the laws of diffusion as the physiologically relevant description. The hyperbolic discrimination line between brain-derived and blood-derived protein fractions in CSF in the quotient diagrams for CSF diagnosis can be further improved on the basis of the large number of cases investigated. Other physiological and pathological aspects, such as high CSF protein values in the normal newborn, in spinal blockade, in meningeal inflammatory processes, CNS leukemia or polyradiculitis as well as animal species dependent variations can each be interpreted as due to a difference or change in the CSF flow rate.