脑脊液寡克隆区带和IgG鞘内合成指标及生化标志物联合应用在多发性硬化鉴别诊断中的价值  

The combined application of oligoclonal bands in cerebrospinal fluid and IgG intrathecal synthesis indicators and biochemical markers in the diagnosis of multiple sclerosis

作　　者：陈柯霖[1] 蒋俊超 姜文灿 王利娟[1] 李斯文 刘紫薇 谷愉愉 张国军[1] Chen Kelin;Jiang Junchao;Jiang Wencan;Wang Lijuan;Li Siwen;Liu Ziwei;Gu Yuyu;Zhang Guojun(Laboratory Diagnosis Center,Beijing Tiantan Hospital,Capital Medical Unversity/Beijing Engineering Research Center of Immunological Reagents Clinical Research/NMPA Key Laboratory for Quality Control of In Vitro Diagnostics,Beijing 100070,China;Respiratory and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京天坛医院实验诊断中心、北京市免疫试剂临床工程技术研究中心、国家药品监督管理局体外诊断试剂质量控制重点实验室,北京100070 [2]中日友好医院呼吸与危重症医学科,北京100020

出　　处：《中华预防医学杂志》2024年第8期1171-1176,共6页Chinese Journal of Preventive Medicine

基　　金：北京市高层次公共卫生技术人才建设项目培养计划(2022-2-013);北京市医院管理中心登峰计划(DFL20220505);北京市医院管理中心-扬帆计划(ZYLX202108);北京市医管中心“青苗”人才项目(QML20230508)。

摘　　要：目的利用寡克隆区带(OCB)联合脑脊液IgG鞘内合成指标和生化标志物建立鉴别多发性硬化(MS)与其他症状相似的神经系统疾病的诊断模型并进行验证。方法选取2014年1月至2022年12月在首都医科大学附属北京天坛医院神经内科收治住院的MS患者为病例组,其他症状相似的神经系统疾病患者为对照组。采用病例对照研究设计,分析所有研究对象的年龄、性别、脑脊液OCB和IgG鞘内合成指标及生化指标。通过多因素logistic回归分析构建鉴别诊断模型,利用受试者工作特征曲线(ROC)分析鉴别诊断模型对MS与其他症状相似的神经系统疾病的鉴别诊断效能。结果本研究病例组纳入167例,对照组纳入335例,其中病例组128例和对照组265例用于构建模型,病例组39例和对照组70例用于模型验证。多因素logistic回归模型构建的鉴别诊断模型为Y=0.871×OCB-0.051×脑脊液蛋白-0.231×脑脊液氯化物+1.183×性别-0.036×乳酸脱氢酶+35.770,该模型ROC曲线下面积为0.916,灵敏度和特异度分别为87.3%和87.6%,且Delong检验结果显示,该模型诊断效力与OCB,IgG鞘内合成指标,OCB联合IgG鞘内合成指标差异有统计学意义(P<0.05)。构建的模型验证显示,对于病例组实际诊断一致率为84.6%,对照组实际诊断一致率为90.0%。结论联合OCB、IgG鞘内合成指标和生化标志物建立MS与其他临床症状相似的神经系统疾病的鉴别诊断模型具有较好的鉴别诊断价值。Objective To establish and verify a diagnostic model for distinguishing multiple sclerosis(MS)from other neurological diseases with similar symptoms by usingcerebrospinal fluid oligoclonal band(CSF-OCB)combined with IgG intrathecal synthesis indicators and biochemical markers.Methods Multiple sclerosis(MS)patients admitted to the Neurology Department of Beijing Tiantan Hospital affiliated with Capital Medical University from January 2014 to December 2022 were selected as the case group,while patients with similar neurological symptoms were selected as the control group.Using the case-control study design,a retrospective analysis was conducted on the detection of age,gender,oligoclonal bands in cerebrospinal fluid,IgG intrathecal synthesis indicators and biochemical indicators for all study subjects.The differential diagnosis model was determined by the multiple logistic regression analysis,and the receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of the differential diagnosis model for neurological diseases with similar symptoms to MS and other conditions.Results This study included 167 patients in the case group and 335 patients in the control group,of which 128 patients in the case group and 265 patients in the control group were used to construct the model,and 39 patients in the case group and 70 patients in the control group were used for model validation.The differential diagnostic model constructed by a multivariate logistic regression model was Y=0.871×CSF-OCB-0.051×CSFprotein-0.231×CSFchloride+1.183×gender-0.036×LDH+35.770.The model showed that the area under the curve,sensitivity and specificity were respectively 0.916,87.3%and 87.6%.The Delong test results showed that the diagnostic efficacy of the model was significantly different from OCB,IgG intrathecal synthesis indicators,and OCB combined with IgG intrathecal synthesis indicators(P<0.05).The new model validation showed that the actual diagnostic consistency rate for the MS group was 84.6%,while the actua

关 键 词：多发性硬化 寡克隆区带 鉴别诊断 病例对照研究 

分 类 号：R744.51[医药卫生—神经病学与精神病学]