Voľné ľahké reťazce kappa pri roztrúsenej skleróze – diagnostická hodnota a porovnanie s ďalšími markermi


Authors: D. Čierny 1;  E. Kantorová 2;  M. Škereňová 1,3;  E. Kurča 2;  J. Lehotský 4;  D. Dobrota 1
Authors‘ workplace: Department of Clinical Biochemistry, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and, University Hospital Martin, Slovak, Republic 1;  Clinic of Neurology, Jessenius Faculty of, Medicine in Martin, Comenius University, in Bratislava and University Hospital, Martin, Slovak Republic 2;  Department of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty, of Medicine in Martin, Comenius, University in Bratislava, Slovak Republic 3;  Department of Medical Biochemistry, and BioMed, Jessenius Faculty of Medicine, in Martin, Comenius University in, Bratislava, Slovak Republic 4
Published in: Cesk Slov Neurol N 2021; 84/117(4): 353-360
Category: Original Paper
doi: 10.48095/cccsnn2021353

Overview

Cieľ: Voľné ľahké reťazce kappa (kappa free light chains; k-fLC) v likvore sú perspektívnym novým markerom intratekálnej syntézy imunoglobulínov (Ig) u pacientov s RS, pričom publikované referenčné hodnoty nie sú jednotné. Cieľom našej práce bolo analyzovať diagnostickú hodnotu k-fLC (hladiny v likvore, kvocientu, indexu) a rutinne vyšetrovaných markerov (IgG index, IgGReiber) v diagnostike RS, v predikcii pozitivity oligoklonálnej skladby (oligoclonal bands; OCB) a u OCB negatívnych pacientov. Metódy: Párované vzorky séra a likvoru boli analyzované v súbore 46 pacientov s RS a 63 kontrolných jedincov s nezápalovými a inými zápalovými ochoreniami CNS. Koncentrácia k-fLC bola meraná imunoturbidimetricky (SPA PLUS®, Freelite®). Pre jednotlivé markery a ich cut-off hodnoty, určené s použitím Youdenovho indexu, boli porovnané ROC krivky, diagnostické senzitivity a špecificity. Výsledky: Optimálne cut-off hodnoty boli: 0,76 pre IgG index; 0,89 mg/l pre IgGReiber; 1,08 mg/l pre hladinu k-fLC v likvore; 0,0994 pre k-fLC kvocient; 18,15 pre k-fLC index. K odlíšeniu RS od control boli zistené najvyššie kombinované diagnostické senzitivity/špecificity pre k-fLC index (0,76/0,98), nasledované k-fLC kvocientom (0,76/0,97), hladinou k-fLC v likvore (0,76/0,95), intratekálnou syntézou IgGReiber (0,70/0,91) a IgG indexom (0,65/0,89). Senzitivita a špecificita OCB vyšetrenia bola 0,83 a 1,00. V predikcii OCB pozitivity malo použitie nových k-fLC markerov excelentnú diagnostickú využiteľnosť so senzitivitou/špecificitou: 0,92/0,99 pre k-fLC index; 0,92/0,97 pre k-fLC kvocient; 0,92/0,96 pre hladinu k-fLC v likvore, v porovnaní s 0,76/0,89 pre IgG index a 0,76/0,86 pre IgGReiber. U OCB negatívnych RS pacientov s použitím navrhnutých cut-off bola najvyššia diagnostická senzitivita (0,38) detekovaná pre IgGReiber, nasledovaná senzitivitou 0,13 pre IgG index a prekvapivo 0,00 senzitiviou pre k-fLC markery. Záver: V diagnostike RS a pri predikcii OCB pozitivity sme detekovali pre všetky analyzované k-fLC markery lepšie diagnostické senzitivity a špecificity v porovnaní s rutinne používaným IgG indexom a IgGReiber, tieto však nedosiahli senzitivitu a špecificitu OCB vyšetrenia. Pre dôkaz intratekálnej syntézy Ig u pacientov so suspektnou RS odporúčame paralelné vyšetrenie OCB spolu s použitím k-fLC indexu a kvocientu, a to predovšetkým ak OCB nález je nejednoznačný alebo negatívny.

Klíčová slova:

roztrúsená skleróza – intratekálna syntéza – voľné ľahké reťazce kappa – index – cerebrospinálny mok – oligoklonálna skladba


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Paediatric neurology Neurosurgery Neurology

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