神经系统疾病患者3217例寡克隆区带检测结果分析  

Analysis of oligoclonal bands detection results of 3217 patients with neurological disorders

作　　者：钮振宇 金海强[1] 郝洪军[1] 郑艺明[1] 郭晶[1] 姚颜 高枫[1] 王朝霞[1] Niu Zhenyu;Jin Haiqiang;Hao Hongjun;Zheng Yiming;Guo Jing;Yao Yan;Gao Feng;Wang Zhaoxia(Laboratory of Neuroimmunology,Department of Neurology,Peking University First Hospital,Beijing Key Laboratory of Neurovascular Disease Discovery,Beijing 100034,China)

机构地区：[1]北京大学第一医院神经内科神经免疫室、神经系统小血管病探索北京市重点实验室,北京100034

出　　处：《中华检验医学杂志》2024年第1期57-64,共8页Chinese Journal of Laboratory Medicine

摘　　要：目的研究各神经系统疾病的寡克隆区带(OCB)阳性率及分型,提示OCB的临床意义及应用价值。方法回顾性分析2012年1月至2022年8月于北京大学第一医院行脑脊液及血清OCB检测的3217例神经系统疾病患者的检测结果。根据出院诊断分为多发性硬化(479例)、视神经脊髓炎谱系疾病(935例)、自身免疫性脑炎(192例)、病毒性脑炎(94例)、造血干细胞移植后神经系统并发症(232例)、格林-巴利综合征(644例)及慢性炎性脱髓鞘性多发性神经根神经病(157例)等13组。使用等电聚焦电泳结合免疫固定法检测患者同期采集的脑脊液及血液样本中的OCB,依据形态学结果将其分为Ⅰ~Ⅴ型,分析各组患者脑脊液OCB阳性率及分型情况。计数资料采用χ^(2)检验进行组间比较。结果多发性硬化、造血干细胞移植后神经系统并发症、自身免疫性脑炎、病毒性脑炎、视神经脊髓炎谱系疾病、格林-巴利综合征及慢性炎性脱髓鞘性多发性神经根神经病组的脑脊液OCB阳性率分别为66.8%(320/479)、48.7%(113/232)、46.4%(89/192)、19.1%(18/94)、17.6%(165/935)、9.9%(64/644)和5.1%(8/157)。其中,多发性硬化、自身免疫性脑炎、病毒性脑炎及视神经脊髓炎谱系疾病组脑脊液OCB阳性患者以Ⅱ型区带为主,分别占阳性患者的94.1%(301/320)、78.7%(70/89)、77.8%(14/18)和77.6%(128/165),提示存在IgG鞘内合成;造血干细胞移植后神经系统并发症、格林-巴利综合征及慢性炎性脱髓鞘性多发性神经根神经病组脑脊液OCB阳性患者以Ⅳ型区带为主,分别占阳性患者的94.7%(107/113)、82.8%(53/64)和8/8,反映无明显鞘内IgG合成。各组患者脑脊液OCB阳性率比较,差异有统计学意义(χ^(2)=1268.31,P<0.001)。结论各组神经系统疾病脑脊液OCB阳性率不同,其中多发性硬化的患者脑脊液OCB阳性率较高,且以Ⅱ型区带为主,提示脑脊液OCB检测及分型可对多种神经系统疾病,尤其是多发性�Objective To study positive rates and typing of oligoclonal bands(OCB)in patients with neurological disorders,and to reveal the clinical significance and applicational value of OCB test.Methods A retrospective analysis was performed on the detection results of 3217 patients with neurological disorders who undertook both serum and cerebrospinal fluid OCBs in the First Hospital of Peking University from January 2012 to August 2022.According to the final diagnosis,the patients were divided into 13 groups including multiple sclerosis(479 cases),neuromyelitis optica spectrum disorders(935 cases),autoimmune encephalitis(192 cases),viral encephalitis(94 cases),nervous system complication after HSCT(232 cases),Guillain-Barrésyndrome(644 cases),chronic inflammatory demyelinating polyneuropathy(157 cases),etc.Cerebrospinal fluid and serum OCBs were detected using isoelectric focusing electrophoresis combining immunofixation,then classified intoⅠ-Ⅴtypes according to the morphology.Consequently,positive rates and types were analyzed for each group.χ^(2) test was used for comparison between groups.Results The positive rates of cerebrospinal fluid OCB in multiple sclerosis,nervous system complication after hematopoietic stem cell transplantation(HSCT),autoimmune encephalitis,viral encephalitis,neuromyelitis optica spectrum disorders,Guillain-Barrésyndrome and chronic inflammatory demyelinating polyneuropathy were respectively 66.8%(320/479),48.7%(113/232),46.4%(89/192),19.1%(18/94),17.6%(165/935),9.9%(64/644),5.1%(8/157).For patients with multiple sclerosis,neuromyelitis optica spectrum disorders,viral encephalitis,and autoimmune encephalitis,TypeⅡbands took the majority of cerebrospinal fluid OCB-positive cases with the rates of 94.1%(301/320),78.7%(70/89),77.8%(14/18),and 77.6%(128/165)respectively,indicating intrathecal IgG synthesis;for patients with nervous system complication after HSCT,Guillain-Barrésyndrome and chronic inflammatory demyelinating polyneuropathy,typeⅣbands took the majority of cerebrospinal f

关 键 词：寡克隆区带 神经系统疾病 脑脊液 

分 类 号：R741[医药卫生—神经病学与精神病学]