RELEVANCE OF CEREBROSPINAL-FLUID VARIABLES FOR EARLY DIAGNOSIS OF NEUROBORRELIOSIS
RELEVANCE OF CEREBROSPINAL-FLUID VARIABLES FOR EARLY DIAGNOSIS OF NEUROBORRELIOSIS
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DOI：
10.1212/wnl.45.9.1663
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发表时间：
1995-09-01
期刊：
影响因子：
9.9
通讯作者：
REIBER, H
中科院分区：
文献类型：
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作者：
TUMANI, H;NOLKER, G;REIBER, H
我们描述的特异性和敏感性相结合的测量基本CSF变量和伯氏疏螺旋体（Bb）特异性IgG和IgM抗体指数（AI）值诊断早期神经疏螺旋体病。基本CSF变量包括总细胞计数、活化B细胞（IgG、伊加和IgM类）的定量、IgG、伊加和IgM的CSF/血清商图（用于定量CSF中的脑源性免疫球蛋白组分）和CSF/血清白蛋白比（作为血-CSF屏障功能的指标）。用ELISA法定量测定脑脊液和血清中免疫球蛋白的B b特异性成分。结果是基于24例明确的神经疏螺旋体病患者，45例其他神经系统疾病患者和28例对照个体的CSF和血清数据。CSF细胞计数升高、IgM类在细胞和鞘内体液免疫应答中占优势以及血-CSF屏障功能障碍的综合证据产生了70%的诊断敏感性和98%的诊断特异性，用于检测神经疏螺旋体病。鞘内产生的Bb特异性IgM，评估为Bb特异性IgM抗体指数（Bb-IgM-AI;病理值> 1.4），诊断敏感性为79%，诊断特异性为96%。相应地，升高的Bb特异性IgG抗体指数（Bb-IgG-AI;病理值> 1.4）显示63%的诊断敏感性和89%的诊断特异性。联合分析Bb特异性AI值和基本CSF变量，得到最高的敏感性（80%）和特异性（98%）。在一个疾病过程中的CSF变量的分析表明，急性与过去的疾病可以区分的基本CSF变量和BB特异性AI的组合。活化B细胞（IgM类）的存在，以82%的诊断灵敏度和94%的诊断特异性指示急性疾病，是有效治疗后最早消失的标志物。
We describe the specificity and sensitivity of measuring a combination of basic CSF variables and Borrelia burgdorferi (Bb)-specific IgG and IgM antibody index (AI) values for the diagnosis of early neuroborreliosis. Basic CSF variables included total cell count, quantitation of activated B cells (IgG, IgA, and IgM classes), CSF/serum quotient diagrams for IgG, IgA, and IgM (to quantitate brain-derived immunoglobulin fractions in CSF), and CSF/serum albumin ratio as a measure of blood-CSF barrier function. The Bb-specific component of immunoglobulins in CSF and serum was quantitated by ELISA. Results are based on data from CSF and serum of 24 patients with definite neuroborreliosis, 45 patients with other neurologic diseases, and 28 control individuals. Combined evidence of an elevated CSF cell count, IgM-class dominance in both the cellular and intrathecal humoral immune response, and blood-CSF barrier dysfunction yielded 70% diagnostic sensitivity and 98% diagnostic specificity for detection of neuroborreliosis. Intrathecal production of Bb-specific IgM, evaluated as Bb-specific IgM antibody index (Bb-IgM-AI; pathologic value > 1.4) showed 79% diagnostic sensitivity and 96% diagnostic specificity. Correspondingly, elevated Bb-specific IgG antibody index (Bb-IgG-AI; pathologic value > 1.4) displayed 63% diagnostic sensitivity and 89% diagnostic specificity. Combined analysis of Bb-specific AI values and basic CSF variables gave the highest sensitivity (80%) and specificity (98%). Analysis of CSF variables over a disease course showed that acute versus past disease could be discriminated by a combination of basic CSF variables and Bb-specific AI. The presence of activated B cells (IgM class), indicative of acute disease with 82% diagnostic sensitivity and 94% diagnostic specificity, is the earliest marker to disappear following effective therapy.