The Value Of Cerebrospinal Fluid Igg Index And Oligoclonal Bands In The Diagnosis Of Multiple Sclerosis

Objectives :To detect the rate of elevated IgG index and positive oligoclonal bands in chinese patients with multiple scleroses, and evaluate the value in the diagnosis of chinese patients with multiple scleroses objectively.Methods: 176 patients who were hospitalized in department of neurology in Wuhan Tongji Hospital during March 2008 to March 2010 were studied, all of these patients were checken IgG index and oligoclonal bands. In these patients, there were 52 multiple sclerosis patients including 31 conventional multiple sclerosis patients and 21 opticospinal multiple sclerosis patients , 87 patients with nervous infections and other inflammatory disorders including 36 patients with infections in center nervous system and 51 patients with idiopathic inflammatory demyelinating diseases, 37 patients with noninflammatory disorders. The 52 multiple sclerosis patients were examined by neurophysiological check (including visual evoked potentials, brainstem auditory evoked potentials, somatosensory evoked potentials) and radiology check (including cranial magnetic resonance scan and contrast scan, cervical vertebrae and thoracic vertebrae scan) further more. Based on the test results, through Chi-square test with SPSS 17.0,the differences of IgG index and oligoclonal bands among these groups were compared. The sensitivitives of the three kinds of auxiliary examination for diagnosis of multiple sclerosis were compared.Results: In multiple sclerosis group, the rate of IgG index >0.7 was 30.77%(16/52), in conventional multiple sclerosis group, the rate of IgG index >0.7 was 35.48%(11/31), in opticospinal multiple sclerosis group, the rate of IgG index >0.7 was 23.81%(5/21), in multiple sclerosis group,the rate of positive oligoclonal bands was 13.46%(7/52), in conventional multiple sclerosis group, the rate of positive oligoclonal bands was 16.13%(5/31), in opticospinal multiple sclerosis group, the rate of positive oligoclonal bands was 9.5%(2/21); in the patients with nervous infections and other inflammatory disorders, the rate of IgG index >0.7 was 24.14%(21/87), in the patients with infections in center nervous system, the rate of IgG index >0.7 was 36.11%(13/36), in the patients with idiopathic inflammatory demyelinating diseases , the rate of IgG index >0.7 was 15.69%(8/51) . in the patients with nervous infections and other inflammatory disorders, the rate of positive oligoclonal bands was 6.90%, in the patients with infections in center nervous system, the rate of positive oligoclonal bands was 8.33%(3/36), in the patients with idiopathic inflammatory demyelinating diseases , the rate of positive oligoclonal bands was 5.9%(3/51); in noninflammatory disorder group, the rate of IgG index >0.7 was 5.41%(2/37), the rate of positive oligoclonal bands was 5.41%(2/37). The indicator of IgG index >0.7 was different between the multiple sclerosis patients and the patients with noninflammatory disorders. The sensitivities of the three paraclinical tests for multiple sclerosis were compared, The sensitivity of cerebrospinal fluid check was 36.54%(19/52), The sensitivity of neurophysiological check was 71.15%(37/52), The sensitivity of radiology check was 86.54%(45/52).Conclusions: the rate of raised IgG index and positive oligoclonal bands in chinese patients with multiple sclerosis is low, the normal result in cerebrospinal fluid can not be considered as an indictor for ruling out diagnosis of multiple sclerosis in chinese patients. IgG index has value in distinguishing multiple sclerosis and noninflammatory disorders. Combined with neurophysiological check and radiology check, multiple sclerosis can be diagnosed more accurately. IgG index and oligoclonal bands have some value in monitoring disease activity and evaluating the effect of treatment and the prognosis of multiple sclerosis too.