多种方法检测视神经脊髓炎患者血清及脑脊液中水通道蛋白4抗体的临床应用

摘要

目的：讨论并分析采用不同方法检测视神经脊髓炎患者血清及脑脊液中水通道蛋白4抗体的临床应用价值。方法分别采用组织间接免疫荧光检测（IIF）、细胞免疫荧光法（CBA）及酶联免疫吸附测定法（ELISA）检测我院2014年1月至2014年12月收治的视神经脊髓炎患者（NMO 组）、多发性硬化患者（MS 组）的血清及脑脊液中水通道蛋白4抗体的表达，同时测定健康受试者（对照组）的血清水通道蛋白4抗体的表达，分析3组间的差异。结果3种方法检测对照组血清中 AQP4-Ab 的表达阳性率均为0．0％。3种方法在 NMO 组与 MS 组患者血清及脑脊液中AQP4-Ab 的阳性结果显示 NMO 组检出率均显著高于 MS 组（P ＜0．05），其中，CBA 在 NMO 组 AQP4-Ab 的阳性检出率最高，分别为血清中73．1％与脑脊液中85．1％。比较3种方法的敏感性：CBA＞IIF＞ELISA；比较3种方法的特异性：CBA＞ELISA＞IIF。其中，3种方法的敏感性有差异（χ2＝7．115，P ＝0．029），3种方法的特异性无差异。结论细胞免疫荧光法检测神经脊髓炎患者的血清及脑脊液中水通道蛋白4抗体的阳性率、敏感性高，适于临床应用。%Objective To analyze the use of different methods to detect AQP4-Ab in serum and cerebrospinal fluid of nuromylitis optica patients.Methods Using IIF,CBA,ELISA to detect expression of AQP4-Ab in serum of three groups of patients (NMO group,MS group and control group)and in cerebrospinal fluid of NMO group plus MS group,the analysis of the differences among the three groups were made after.Results The control group had no posi-tive result in serum detection of all the methods above.The NMO group had the significant higher positive rates on AQP4-Ab of both serum and cerebrospinal fluid among three groups than MS group(P < 0.05).And the CBA for AQP4-Ab-positive detection had the highest rate(73.1% in serum,85.1% in cerebrospinal fluid).The comparison of the sensitivity:CBA> IIF> ELISA,which had statistical significance (χ2 = 7.115,P = 0.029);specificity :CBA>ELISA>IIF,which didn’t have statistical significance.Conclusion Immunofluorescence assay provides high sensitivi-ty,high positive rate of AQP4-Ab detection in serum and cerebrospinal fluid of patients with nuromylitis optica,which is suitable for clinical application.