Diagnostic value of serum and cerebral spinal fluid aquaporin 4-IgG detected by indirect immunofluorescence assays using different base in neuromyelitis optica / 中华神经科杂志

ABSTRACT

Objective To explore the diagnostic value of serum and cerebral spinal fluid (CSF) aquaporin 4(AQP4)-IgG detected by indirect immunofluorescence assay (ⅡFA) using monkey optical nerve and AQP4 transfected cell as base in neuromyelitis optica (NMO).Methods Serum and CSF AQP4-IgG in 32 NMO patients,41 multiple sclerosis (MS) patients,33 non-inflammatory neurological disease (NIND) patients and serum AQP4-IgG in 20 healthy controls (HC) were detected by monkey optical nerve/AQP4 transfected cell-based IIFA.Results (1) In both optical nerve and AQP4 transfected cell based IIFA,compared with MS,NIND and HC,the patients with NMO had significantly higher positive rate of AQP4-IgG in both serum (optical nerve-based IIFA:NMO 46.9％ (15/32),MS 7.3％ (3/41),NIND 3.0％ (1/33),HC 0 (0/20),P ＜ 0.01 ; cell-based IIFA:NMO 84.4％ (27/32),MS 2.4％ (1/41),NIND 3.0％ (1/33),HC 0 (0/20),P ＜0.01) and CSF (optical nerve-based ⅡFA:NMO 21.9％ (7/32),MS 0 (0/41),NIND 0 (0/33),P ＜ 0.01 ; cell-based IIFA:NMO 56.3％ (18/32),MS 0 (0/41),NIND 0(0/33),P＜0.01); sensitivity of serum AQP4-IgG (optical nerve-based IIFA 46.9％; cell-based IIFA 84.4％) was significantly higher than that of CSF AQP4-IgG (optical nerve-based IIFA 21.9％,P ＜0.01 ; cell-based IIFA 56.3 ％,P ＜ 0.05),while no significant difference was found in specificity between serum and CSF AQP4-IgG in diagnosing NMO; using combination of serum and CSF AQP4-IgG applied,the sensitivity increased (optical nerve-based IlFA 46.9％ vs 50.0％ ; cell-based IIFA 84.4％ vs 87.5％) while specificity remained no change.(2) Compared with optical nerve-based IIFA (serum 46.9％,CSF 21.9％),cell-based IIFA had higher sensitivity in diagnosing NMO (serum 84.4％ ; CSF 56.3％,P ＜ 0.01),while no significant difference of specificity between these two methods.Conclusion It has better clinical value to detect serum and CSF AQP4-IgG at the same time by AQP4 transfected cell based IIFA in diagnosing NMO.