| Abstract | Ciljevi: Cilj je istraţivanja prikazati imunološka i mikrobiološka obiljeţja MS-a na temelju nalaza likvorske dijagnostike te serološke i mikrobiološke obrade ispitanika.
Ispitanici i postupci: Provedeno je retrospektivno kohortno istraţivanje na 100 ljudi oboljelih od MS-a s nalazima likvorske, imunološke i mikrobiološke obrade. Podatci iz 2020. i 2021. godine prikupljeni u dnevnoj bolnici Klinike za neurologiju KBC-a Split uključivali su podatke o spolu, godini roĎenja, prvome simptomu, godini njegove pojave i godini postavljanja dijagnoze te nalaze likvorske, imunološke i mikrobiološke obrade. Rezultati su prikazani uz pomoć apsolutnih i relativnih brojeva, a statistička povezanost interpretirana je na razini značajnosti od P<0,05.
Rezultati: U istraţivanju je sudjelovalo 76% ţena i 24% muškaraca. Medijan dobi ispitanika pri pojavi prvih simptoma iznosio je 34,5, a pri postavljanju dijagnoze 35 godina. U 82,7% ispitanika dijagnoza je postavljena unutar prve 2 godine od pojave simptoma. Najčešći su bili ispadi vida i osjeta, a atipične prve simptome imalo je 11,2% ispitanika. Povećan broj leukocita u likvoru imalo je 26%, a povećanu koncentraciju proteina 48% ispitanika. Koncentracije glukoze i laktata većinom su bile unutar referentnih vrijednosti. Pozitivne OCB u likvoru imalo je 71,4% ispitanika, a statistički su značajno povezane s brojem leukocita u likvoru. Medijan broja serološki testiranih autoantitijela po ispitaniku iznosio je 21, a povećan je samo udio pozitivnih ANA (29,8%). Autoantitijela nisu povezana s prvim simptomom niti s nalazima likvora. Svi su ispitanici seropozitivni na IgG na EBV, a intratekalna sinteza IgG-a na EBV prisutna je samo u 4,6% ispitanika. Virusi s najčešćom intratekalnom sintezom IgG-a jesu VZV (25%), virus rubele (22,9%), ospica (11,9%) i HSV (11,8%). Intratekalna sinteza antiviralnoga IgG-a nije povezana s prvim simptomima niti s nalazima likvora, no povezana je s tipom OCB-a (P<0,001).
Zaključci: MS karakteriziraju normalne ili blago povišene vrijednosti leukocita i proteina te uredne vrijednosti glukoze i laktata u likvoru. OCB prisutne su u likvoru većine bolesnika, no nisu povezane s prvim simptomima. U obradi pacijenata s MS-om radi se velik broj imunoloških pretraga koje nemaju utjecaja na promjene u likvoru niti na kliničku prezentaciju. ANA su češće povišena u MS-u, no serumska autoantitijela nisu povezana s inicijalnom prezentacijom i nalazima likvora. Stopostotna seropozitivnost na EBV IgG upućuje na njegovu moguću patogenetsku ulogu. Intratekalna sinteza IgG-a najčešća je na VZV, rubele, ospice i HSV i povezana je s tipom OCB-a. |
| Abstract (english) | Objectives: The aim of this research was to show the immunological and microbiological characteristics of MS based on cerebrospinal fluid (CSF), serological and microbiological findings. The main goal was to point out the contribution of immunological and microbiological analysis to the diagnosis of MS.
Subjects and methods: A retrospective cohort study was conducted on 100 MS patients who underwent CSF, immunological and microbiological processing. Data from 2020 and 2021 collected in the daily clinic of the Department of Neurology at University Hospital of Split included gender, year of birth, first symptom, year of onset and year of diagnosis, as well as CSF, immunological and microbiological findings. The results are presented with the help of absolute and relative numbers, and the statistical association is interpreted at the significance level of P<0.05.
Results: In this research, there was 76% of women and 24% of men. The median age of patients when the first symptoms appeared was 34.5 years, and 35 years when the diagnosis was made. In 82.7% of subjects, the diagnosis was made within the first 2 years from symptoms onset. The most common were visual and sensory disturbances, while 11.2% of respondents had atypical first symptoms. In 26% of participants leukocyte count in CSF was increased, while 48% of participants had increased protein levels. Glucose and lactate levels were mostly within reference values. Positive oligoclonal bands (OCBs) were detected in 71.4% of patients. The OCBs were significantly related to the number of leukocytes in the CSF. The median number of serologically tested autoantibodies per subject was 21, with only ANA showing an increased proportion of positive results (29.8%). Autoantibodies were not associated with clinical onset or CSF findings. All subjects were EBV IgG seropositive, but intrathecal synthesis of EBV IgG was present only in 4.6% of them. The viruses against which intrathecal IgG synthesis was most common were VZV (25%), rubella (22.9%), measles (11.9%) and HSV (11.8%). Intrathecal synthesis of antiviral IgG was not associated with first symptoms or with CSF findings, but was associated with the OCB type (P<0.001).
Conclusions: MS is characterized by normal or slightly elevated values of leukocytes and proteins and normal values of glucose and lactate in the CSF. OCBs are present in the CSF of most patients, but are not related to the first clinical presentation. In the processing of patients with MS, a large number of immunological tests are performed, which have no effect on thechanges in the CSF or on the clinical presentation. The frequency of positive ANA is increased in MS, but with no clear association with initial symptoms and CSF findings. A 100% seropositivity for EBV IgG points to its possible role in the pathogenesis of MS. Intrathecal IgG synthesis is most common against VZV, rubella, measles and HSV viruses, and it is significantly related to the OCB type. |
