| Abstract | Cilj istraživanja:
Cilj ovog rada bio je istražiti povezanost broja oligoklonskih vrpca u likvoru s težinom bolesti, izraženom EDSS-ocjenom, prilikom prvog napada bolesti prepoznatog u sklopu multiple skleroze.
Ustroj istraživanja:
Provedeno je presječno istraživanje. Podatci o težini bolesti, izraženi EDSS-ocjenom, bolesnika oboljelih od multiple skleroze prikupljeni su pretraživanjem pismohrane Klinike za neurologiju. Uvidom u pismohranu Odjela za medicinsko-laboratorijsku dijagnostiku prikupljeni su podatci o broju oligoklonskih vrpca i koncentracijama Ig G, Ig M, albumina u likvoru i serumu.
Mjesto istraživanja:
Ovo istraživanje provedeno je u Kliničkom bolničkom centru, Klinika za neurologiju i Odjel za medicinsko-laboratorijsku dijagnostiku.
Sudionici:
U istraživanje je uključeno 56 ispitanika hospitaliziranih u razdoblju od 1. siječnja 2010. do 1. travnja 2012. godine kojima je postavljena dijagnoza multiple skleroze.
Glavne mjere ishoda:
Broj oligoklonskih vrpca i težina kliničke slike su glavne mjere ishoda.
Rezultati:
Od ukupnog broja ispitanika bilo je 39 žena (69,6%) i 17 muškaraca (30,4%). Općenito težina multiple skleroze, ocjenjena prema kriteriju EDSS, prosječno je bila 1.4±1.3. Promjene u funkciji piramidnog sustava bile su najčešći poremećaj (87,5% bolesnika) te je povezan s težim oblikom bolesti (Spearmanov koeficijent korelacije=0.797, P<0.001). Istraživanje je pokazalo da povezanost težine bolesti u trenutku konačne dijagnoze, prikazane EDSS ocjenom, u vrijeme prve pojave simptoma i broja oligoklonskih vrpca je pozitivna, ali slaba i statistički nije značajna (Speramanov koeficijent korelacije ranga=0,156, P=0,126). Nema povezanosti broja oligoklonskih vrpca i broja zahvaćenih sustava (Pearsonov koeficjent=0,093, P=0,248). Multipla skleroza kod muškaraca počinje težim simptomima (Mann-Whitneyim testom, Z=-2,501, P=0.012). Ukoliko u muškaraca ranije počinje težeg je oblika, dok kod žena tek u kasnijim godinama ima teži oblik (test razlike dvaju koeficijenata korelacije; P=0,0472).
Istodobno povišenje IgG prati povišenje IgM (Pearsonov koeficijent korelacije rangova 0,228 (P=0,047). Povezanost Ig G indeksa i Ig M indeksa, i težine bolesti je pozitivna, ali slaba i statistički nije značajna. Spearmanov koeficjent korelacije indeksa IgG s EDSS-ocjenom iznosi 0,119 (P=0,193), a koeficjent korelacije indeksa IgM s EDSS-ocjenom iznosi 0,176 (P=0,099). Povišenje indeksa IgM u muškaraca je povezan s težim stupnjem bolesti (Spearmanov koeficijent korelacije 0,579, P=0,007)
Zaključak:
Imunološki parametri oligoklonske vrpce i indeks IgG imaju pozitivnu, ali statističku neznačajnu povezanost s težinom bolesti u trenutku konačne dijagnoze. Povišenje indeksa IgM u muškaraca je povezan s težim stupnjem bolesti. |
| Abstract (english) | Objectives:
The aim of this study was to investigate the connection between the number of oligoclonal bands in CSF with the severity of the disease, expressed by the EDSS-score during the first attack of disease recognized as part of multiple sclerosis.
Design:
A cross-sectional study has been conducted. Data on disease severity, expressed by the EDSS score, of the patients with multiple sclerosis were collected by searching through the archives of the Department of Neurology. After browsing the archives of the Department of Medical Diagnostic Laboratory, data on the number of oligoclonal bands and the concentrations of IgG, IgM and albumin in CSF and serum were collected.
Setting:
This study was conducted at the Clinical Hospital Center, Department of Neurology and Department of Medical Diagnostic Laboratory.
Participants:
The study included 56 patients hospitalized in the period from 1 January 2010 to 1 April 2012, who were diagnosed with multiple sclerosis.
Main outcome measures:
Number of oligoclonal bands and severity of clinical features were the main outcome measures. Results:
Of the total number of the examinees, there were 39 women (69.6%) and 17 males (30.4%). Overall disease severity, expressed with EDSS-scale, was averagely 1.4 (± 1.3). Changes in function of the pyramidal system were the most common disorder (87.5% of patients) and were associated with severe disease (Spearman correlation coefficient=0797, P=0.00001). Research has shown that the correlation between disease severity at the time of final diagnosis, shown by the EDSS-score, and the number of oligoclonal bands at the time of first onset of symptoms is positive, but weak, and is not statistically significant (Speramanov rank correlation coefficient=0.156, P=0.126). There is no connection between the number of oligoclonal bands and the number of affected systems (Pearson coefficient=0.093, P =0.248). Multiple sclerosis in men starts with more severe symptoms (Mann-Whitney test, Z=-2.501, P=0.012). If starting at earlier age in men, it has more severe form, whereas in women only in the later years it gets severe form (the test of two coefficients of correlation, P=0.047).
At the same time, the increase of IgG is followed by the increase of IgM (Pearson rank correlation coefficient 0.228 (P=0.047). Correlation between index IgG and index IgM and the severity of the disease is positive, but weak, and not statistically significant. Spearman coefficient of correlation for IgG index and EDSS-score was 0.119 (P=0.193), and the coefficient of correlation of IgM index and EDSS-score was 0, 176 (P=0.099). The increase of Ig M index in men is associated with more severe form of illness (Spearman correlation coefficient 0.579, P=0.007).
Conclusion:
Immunological parameters of oligoclonal bands and IgG index are positively, but statistically insignificantly, correlated with disease severity at the time of final diagnosis. The increase of Ig M index in men is associated with more severe form of illness. |
