{"id":1078,"date":"2016-12-08T21:59:57","date_gmt":"2016-12-08T20:59:57","guid":{"rendered":"http:\/\/www.newslab.sk\/2016\/12\/08\/likvorova-diagnostika-ochoreni-postihujucich-nervovy-system\/"},"modified":"2017-10-04T14:42:18","modified_gmt":"2017-10-04T12:42:18","slug":"cerebrospinal-fluid-diagnosis-of-diseases-affecting-the-nervous-system","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/cerebrospinal-fluid-diagnosis-of-diseases-affecting-the-nervous-system\/","title":{"rendered":"Cerebrospinal fluid diagnosis of diseases affecting the nervous system"},"content":{"rendered":"<pre><strong><span style=\"color: #ff0000;\">*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf \r\nattachment at the end of the paper. \u00a0<\/span><\/strong><\/pre>\n<p>&nbsp;<\/p>\n<p><strong>\u00da<\/strong><strong>vod<\/strong><\/p>\n<p>Z\u00e1kladn\u00e9 biochemick\u00e9 a cytologick\u00e9 \u00a0vy\u0161etrenie likvoru tvor\u00ed z\u00e1klad \u0161tandardnej diagnostiky ak\u00fatnych ochoren\u00ed postihuj\u00facich \u00a0nervov\u00fd syst\u00e9m, preto\u017ee poskytuje cenn\u00e9 vstupn\u00e9 inform\u00e1cie o mo\u017enom charaktere ochorenia. Vyu\u017eit\u00edm vysokocitliv\u00fdch imunochemick\u00fdch met\u00f3d m\u00f4\u017eeme n\u00e1sledne \u0161pecifikova\u0165 pr\u00edslu\u0161n\u00e9 patologick\u00e9 procesy. Ke\u010f\u017ee likvor je ultrafiltr\u00e1t plazmy, mnoh\u00e9 analyty sa paralelne stanovuj\u00fa v likvore aj v krvi a n\u00e1sledne sa hodnotia vzh\u013eadom na priepustnos\u0165 hematolikvorovej bari\u00e9ry. Odber likvoru z diagnostick\u00fdch \u00a0i terapeutick\u00fdch d\u00f4vodov sa naj\u010dastej\u0161ie vykon\u00e1va lumb\u00e1lnou punkciou (LP).<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>I<\/strong><strong>n<\/strong><strong>dik<\/strong><strong>\u00e1<\/strong><strong>c<\/strong><strong>i<\/strong><strong>e vy\u0161etrenia likvoru:<\/strong><\/p>\n<ol>\n<li><strong>Z\u00e1palov\u00e9 ochorenia nervov\u00e9ho syst\u00e9mu<\/strong><\/li>\n<\/ol>\n<ul>\n<li>ak\u00fatne neuroinfekcie (hnisav\u00e9, ser\u00f3zne)<\/li>\n<li>z\u00e1paly autoimunitn\u00e9ho p\u00f4vodu<br \/>\nCNS: sclerosis multiplex (SM), neuromyelitis optica, ak\u00fatna demyeli- nizuj\u00faca encefalomyelit\u00edda,<br \/>\nPNS: GBS, AIDP, CIDP a varianty<\/li>\n<li>syst\u00e9mov\u00e9 autoimunitn\u00e9 ochorenia postihuj\u00face nervov\u00fd syst\u00e9m (vaskulit\u00eddy, SLE a in\u00e9)<\/li>\n<\/ul>\n<ol start=\"2\">\n<li><strong>Subarachnoid\u00e1lne krv\u00e1canie<br \/>\n<\/strong><\/li>\n<li><strong>N\u00e1dorov\u00e9 postihnutie CNS<\/strong><\/li>\n<\/ol>\n<ul>\n<li>mal\u00edgna meninge\u00e1lna \u00a0infiltr\u00e1cia (karcinomat\u00f3zna, leukemick\u00e1)<\/li>\n<li>paraneoplastick\u00e9 likvorov\u00e9 syndr\u00f3my<\/li>\n<\/ul>\n<ol start=\"4\">\n<li><strong>Neurodegenerat\u00edvne ochorenia<\/strong><\/li>\n<\/ol>\n<ul>\n<li>Creutzfeldova-Jacobova choroba, Alzheimerova choroba, amyotrofick\u00e1 later\u00e1lna skler\u00f3za, Parkinsonova choroba<\/li>\n<\/ul>\n<ol start=\"5\">\n<li><strong>Likvorea<\/strong><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><strong>Z<\/strong><strong>\u00e1<\/strong><strong>k<\/strong><strong>l<\/strong><strong>a<\/strong><strong>d<\/strong><strong>n<\/strong><strong>\u00e1 likvorol\u00f3gia<\/strong><\/p>\n<p><strong>Bielkoviny v likvore (proteinorachia)<\/strong><\/p>\n<p>Asi 80 % bielkov\u00edn v likvore poch\u00e1dza z perif\u00e9rnej krvi, zvy\u0161n\u00fdch<\/p>\n<p>20 % vznik\u00e1 intratek\u00e1lne v mozgovom parench\u00fdme a leptomeningoch. \u00a0Hyperproteinorachia \u00a0je patologick\u00fd jav, ktor\u00fd vznik\u00e1 ako d\u00f4sledok:<\/p>\n<ul>\n<li>zv\u00fd\u0161enej priepustnosti hematolikvorovej bari\u00e9ry<\/li>\n<li>intratek\u00e1lnej synt\u00e9zy prote\u00ednov<\/li>\n<li>poruchy cirkul\u00e1cie likvoru<\/li>\n<\/ul>\n<p><strong>Gluk\u00f3za v likvore (glykorachia)<\/strong><\/p>\n<p>Gluk\u00f3za je hlavn\u00fd energetick\u00fd substr\u00e1t mozgov\u00e9ho tkaniva. Prostredn\u00edctvom transportn\u00fdch syst\u00e9mov v plexus chorioideus je z \u00a0perif\u00e9rnej krvi transportovan\u00e1 do \u00a0mozgu. \u00a0A si 60\u00a0 \u2013 \u00a070\u00a0 % koncentr\u00e1cie gluk\u00f3zy v likvore (odobrat\u00e9ho LP) poch\u00e1dza z perif\u00e9rnej krvi. Glykorachia \u00a0je preto ur\u010den\u00e1 kapacitou t\u00fdchto pren\u00e1\u0161a\u010dov\u00fdch syst\u00e9mov, \u00a0vyu\u017eit\u00edm gluk\u00f3zy v mozgu a jej reabsorpciou v likvore.<\/p>\n<p><strong>Patologick\u00e9 hodnoty:<\/strong><\/p>\n<p>Hyperglykorachia \u2013 pri hyperglyk\u00e9mii (napr\u00edklad diabetici) Hypoglykorachia \u2013 bakteri\u00e1lne meningit\u00eddy, n\u00e1dorov\u00e9 ochorenia postihuj\u00face CNS, isch\u00e9mie mozgu, SAK.<br \/>\n<strong>Lakt\u00e1t v likvore<\/strong><\/p>\n<p>Lakt\u00e1t vznik\u00e1 priamo \u00a0v mozgov\u00fdch \u00a0bunk\u00e1ch pri glykol\u00fdze za anaer\u00f3bnych podmienok. Na rozdiel od gluk\u00f3zy jeho koncentr\u00e1cia v likvore nez\u00e1vis\u00ed od koncentr\u00e1cie v plazme. Lakt\u00e1t spolu s gluk\u00f3zou s\u00fa hlavn\u00fdmi markermi na rozl\u00ed\u0161enie hnisavej meningit\u00eddy od nehnisavej.<\/p>\n<p><strong>Patologick\u00e9 hodnoty:<\/strong><\/p>\n<p>Zv\u00fd\u0161en\u00e1 koncentr\u00e1cia lakt\u00e1tu<\/p>\n<ul>\n<li>bakteri\u00e1lne meningit\u00eddy<\/li>\n<li>CMP (spojen\u00e1 s \u0165a\u017ekou hypoxiou mozgu)<\/li>\n<li>SAK<\/li>\n<li>mal\u00edgna infiltr\u00e1cia mozgov\u00fdch \u00a0obalov<\/li>\n<li>metabolick\u00e9 ochorenia postihuj\u00face CNS (napr\u00edklad mitochondri\u00e1lna encefalomyopatia)<\/li>\n<\/ul>\n<p><strong>Cytol\u00f3gia likvoru<\/strong><\/p>\n<p>Cytologick\u00fd n\u00e1lez umo\u017e\u0148uje odhali\u0165 neoplastick\u00fd proces v intratek\u00e1lnom priestore alebo potvrdi\u0165 subarachnoid\u00e1lne krv\u00e1canie v pr\u00edpadoch, ke\u010f zobrazovacie met\u00f3dy zlyhali (negat\u00edvny n\u00e1lez CT). Prednos\u0165ou kvalitat\u00edvnej cytol\u00f3gie je mo\u017enos\u0165 \u00a0pozorova\u0165 v jednom obraze dve \u0161t\u00e1di\u00e1 krv\u00e1cania naraz (\u010derstv\u00e9 a star\u00e9 krv\u00e1canie). Kvantitat\u00edvna cytol\u00f3gia sa hodnot\u00ed vo Fuchsovej-Rosenthalovej kom\u00f4rke. Stanov\u00ed sa po\u010det mononukle\u00e1rov, polynukle\u00e1rov a erytrocytov. Fyziologick\u00fd n\u00e1lez je do 10 buniek\/3 \u00b5l, u novorodencov do 90 buniek\/3 \u00b5l. Pr\u00edtomnos\u0165 \u00a0patologick\u00fdch \u00a0buniek pri fyziologickom \u00a0po\u010dte buniek sa\u00a0ozna\u010duje \u00a0ako patologick\u00e1 oligocyt\u00f3za \u00a0(tabu\u013eka 1). Pri zv\u00fd\u0161enom \u00a0po\u010dte buniek v likvore hovor\u00edme o pleiocyt\u00f3ze (tabu\u013eka 2).<\/p>\n<p>Zhodnotenie morfol\u00f3gie buniek (kvalitat\u00edvny cytologick\u00fd n\u00e1ter) je s\u00fa\u010das\u0165ou \u00a0ka\u017edej cytol\u00f3gie \u00a0likvoru. V\u00fdznam \u00a0m\u00e1 najm\u00e4 pri n\u00e1dorov\u00fdch ochoreniach postihuj\u00facich nervov\u00fd syst\u00e9m, preto\u017ee pri stanoven\u00ed po\u010dtu buniek kom\u00f4rkovou met\u00f3dou n\u00e1dorov\u00e9 bunky mnohokr\u00e1t nie je mo\u017en\u00e9 zachyti\u0165, respekt\u00edve nie je mo\u017en\u00e9 ich spr\u00e1vne identifikova\u0165. Za fyziologick\u00fdch podmienok sa v likvore nach\u00e1dzaj\u00fa mononukle\u00e1ry, t. j. lymfocyty \u00a0(fyziologicky \u00a0do 10 % v aktivovanom stave) a monocyty\u00a0(v pokoji) v pomere 7\/3, ojedinele \u00a0aj bunky v\u00fdstelky likvorov\u00fdch ciest. U novorodencov s\u00fa okrem mononukle\u00e1rov v likvore pr\u00edtomn\u00e9 \u00a0aj neutrofiln\u00e9 granulocyty (ich pr\u00edtomnos\u0165 s\u00favis\u00ed s nezrelos\u0165ou mozgov\u00fdch bari\u00e9r).<\/p>\n<p><strong>Zast\u00fapenie buniek v likvore za patologick\u00fdch podmienok:<\/strong><\/p>\n<ul>\n<li>aktivovan\u00e9 lymfocyty (nad 10 %)<\/li>\n<li>plazmatick\u00e9 bunky<\/li>\n<li>aktivovan\u00e9 monocyty<\/li>\n<li>granulogyty \u00a0(neutrofily, eozinofily, bazofily)<\/li>\n<li>erytrocyty<\/li>\n<li>makrof\u00e1gy s pr\u00edslu\u0161n\u00fdm substr\u00e1tom:<br \/>\nerytrof\u00e1g (\u010derstv\u00e9 krv\u00e1canie) (obr\u00e1zok 3) siderof\u00e1g (star\u0161ie krv\u00e1canie)<br \/>\nsiderof\u00e1g s kry\u0161t\u00e1lom hematoid\u00ednu \u00a0(star\u0161ie krv\u00e1canie)<br \/>\nleukof\u00e1g (hnisav\u00e9 z\u00e1paly)<br \/>\nlymfof\u00e1g (v\u00edrusov\u00e9 z\u00e1paly,sclerosis multiplex) (obr\u00e1zok 4)<br \/>\nlipof\u00e1g (de\u0161trukcia tkaniva CNS)<br \/>\nmykof\u00e1g (mykotick\u00e9 ochorenia CNS)<\/li>\n<li>mal\u00edgne bunky pri prim\u00e1rnych n\u00e1doroch \u00a0(n\u00e1dorov\u00fd proces\u00a0 v CNS alebo v bl\u00edzkosti likvorov\u00fdch ciest) alebo pri sekund\u00e1rnych tumoroch (CA prsn\u00edka (obr\u00e1zok 5), Ca hrub\u00e9ho \u010dreva, CA p\u013e\u00fac, melan\u00f3m) a he- matoonkologick\u00fdch ochoreniach (leuk\u00e9mie, lymf\u00f3my (obr\u00e1zok 6))<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>\u0160<\/strong><strong>pe<\/strong><strong>c<\/strong><strong>i\u00e1l<\/strong><strong>n<\/strong><strong>a likvorol\u00f3gia<\/strong><\/p>\n<p>Hematolikvorov\u00e1 bari\u00e9ra (HLB) zabezpe\u010duje \u00a0komunik\u00e1ciu medzi krvn\u00fdm syst\u00e9mom \u00a0a likvorom. Dominantn\u00fdm\u00a0 transportn\u00fdm mechanizmom \u00a0v plexus chorioideus \u00a0je dif\u00fazia. Prote\u00edny prech\u00e1dzaj\u00fa \u00a0z krvi do likvoru aj pinocyt\u00f3zou \u00a0alebo \u0161pecifick\u00fdmi pren\u00e1\u0161a\u010dmi. Sledovanie permeability HLB tvor\u00ed z\u00e1klad monitorovania biochemick\u00fdch \u00a0a imunologick\u00fdch procesov prebiehaj\u00facich pri mnoh\u00fdch neurologick\u00fdch ochoreniach (tabu\u013eka 3).<\/p>\n<p>Album\u00ednov\u00fd kvocient \u2013 Q (Alb) je marker na pos\u00fadenie selektivity HLB. Hodnoty albuminorachie a album\u00ednov\u00e9ho kvocientu s\u00fa nielen mierou priepustnosti bari\u00e9ry, ale upozor\u0148uj\u00fa\u00a0 aj na z\u00e1pal, mo\u017en\u00fa prek\u00e1\u017eku v likvorov\u00fdch cest\u00e1ch (najm\u00e4 v miechovom kan\u00e1le) alebo na z\u00e1va\u017en\u00fd metabolick\u00fd rozvrat (napr\u00edklad porucha acidob\u00e1zickej rovnov\u00e1hy).<\/p>\n<p>Do likvoru sa album\u00edn \u00a0dost\u00e1va \u00a0v\u00fdlu\u010dne \u00a0len z perif\u00e9rnej krvi, a to procesom ultrafiltr\u00e1cie krvnej plazmy cez plexus chorioideus. Patologick\u00e9 stavy nar\u00fa\u0161aj\u00face regula\u010dn\u00e9 mechanizmy HLB sp\u00f4sobuj\u00fa zv\u00fd\u0161en\u00fa koncentr\u00e1ciu album\u00ednu v likvore.\u00a0Album\u00ednov\u00fd\u00a0 kvocient je dan\u00fd pomerom: Q(Alb) = (CSF &#8211; Alb\/S &#8211; Alb) x 10-3.<\/p>\n<p><strong><br \/>\nHumor\u00e1lna imunita v CNS<\/strong><\/p>\n<p>Aj za fyziologick\u00fdch podmienok v CNS nach\u00e1dzame protil\u00e1tky, ktor\u00e9 poch\u00e1dzaj\u00fa zo syst\u00e9movej cirkul\u00e1cie. Pri z\u00e1palov\u00fdch procesoch, v d\u00f4sledku intratek\u00e1lnej synt\u00e9zy, doch\u00e1dza k zv\u00fd\u0161eniu ich koncentr\u00e1cie v likvore. T\u00e1to synt\u00e9za protil\u00e1tok v CNS poch\u00e1dza z perivaskul\u00e1rnych infiltr\u00e1tov B-lymfocytov, ktor\u00e9 tu lok\u00e1lne proliferuj\u00fa na plazmatick\u00e9 bunky a n\u00e1sledne produkuj\u00fa pr\u00edslu\u0161n\u00e9 protil\u00e1tky. Humor\u00e1lna imunitn\u00e1 odpove\u010f v CNS je odli\u0161n\u00e1 od imunitnej odpovede v krvi. Charakteristick\u00e1\u00a0 tvorba protil\u00e1tok vo v\u0161etk\u00fdch triedach IgG\/ IgM\/IgA \u00a0je v CNS pr\u00edtomn\u00e1 na za\u010diatku ochorenia \u00a0a n\u00e1sledne zost\u00e1va relat\u00edvne kon\u0161tantn\u00e1. D\u013a\u017eka trvania intratek\u00e1lnej produkcie protil\u00e1tok z\u00e1vis\u00ed od p\u00f4vodcu ochorenia, lokaliz\u00e1cie dan\u00e9ho procesu a patofyziologick\u00fdch mechanizmov ochorenia (tabu\u013eka 4).<\/p>\n<p><strong>Mo\u017en\u00e9 pr\u00ed\u010diny intratek\u00e1lnej humor\u00e1lnej odpovede:<\/strong><\/p>\n<ul>\n<li>ak\u00fatne z\u00e1palov\u00e9 ochorenie \u00a0v CNS so \u0161pecifickou odpove\u010fou na infek\u010dn\u00fd agens (v\u00edrusy, bakt\u00e9rie, parazity)<\/li>\n<li>zostatkov\u00e1 intratek\u00e1lna synt\u00e9za protil\u00e1tok po prekonan\u00ed infekcie (pokles synt\u00e9zy protil\u00e1tok bez klinick\u00fdch sympt\u00f3mov)<\/li>\n<li>chronick\u00fd z\u00e1palov\u00fd proces autoimunitn\u00e9ho charakteru (poly\u0161pecifick\u00e1 protil\u00e1tkov\u00e1 odpove\u010f bez d\u00f4kazu vyvol\u00e1vaj\u00faceho antig\u00e9nu)<\/li>\n<\/ul>\n<p><strong>Mo\u017enosti d\u00f4kazu intratek\u00e1lnej oligoklonovej produkcie protil\u00e1tok:<\/strong><\/p>\n<ul>\n<li>v\u00fdpo\u010dtom pod\u013ea Reibera, Linka (tzv. IgG index), ide o odhad intratek\u00e1lnej tvorby protil\u00e1tok<\/li>\n<li>izoelektrick\u00e1 fokus\u00e1cia (IEF) pova\u017eovan\u00e1 za zlat\u00fd \u0161tandard<\/li>\n<\/ul>\n<p>Detekcia intratek\u00e1lnej oligoklonovej produkcie \u00a0protil\u00e1tok IgG v likvore m\u00e1 ve\u013ek\u00fa v\u00fdpovedn\u00fa \u00a0hodnotu pri diagnostikovan\u00ed z\u00e1palov\u00fdch demyeliniza\u010dn\u00fdch ochoren\u00ed CNS ako sclerosis multiplex, pri mo\u017en\u00fdch autoimunitn\u00fdch ochoreniach postihuj\u00facich CNS, pri paraneoplastick\u00fdch ochoreniach, \u00a0pri ser\u00f3znych \u00a0neuroinfekci\u00e1ch \u00a0i pri postinfek\u010dn\u00fdch demyeliniza\u010dn\u00fdch \u00a0encefalit\u00eddach \u00a0(prekonanie ne\u0161pecifickej v\u00edrusovej infekcie, reakcia po o\u010dkovan\u00ed) \u2013 tabu\u013eka 5. Pri postinfek\u010dn\u00fdch demyeliniz\u00e1ci\u00e1ch poz\u00edcie oligoklonov\u00fdch IgG gradientov (pohyblivos\u0165 preva\u017ene v neutr\u00e1lnej a kyslej oblasti pH-gradientu) po ur\u010ditom \u010dase vymizn\u00fa. Pri klinicky definit\u00edvnej \u00a0sclerosis \u00a0multiplex \u00a0s\u00fa poz\u00edcie oligoklonov\u00fdch IgG nemenn\u00e9 \u00a0(pohyblivos\u0165 v alkalickej oblasti\u00a0pH-gradientu). S \u010dasom m\u00f4\u017eu len prib\u00fada\u0165 \u010fal\u0161ie gradienty, popr\u00edpade sa men\u00ed intenzita oligoklonov\u00fdch IgG gradientov (1, 5).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Intratek\u00e1lna synt\u00e9za \u0161pecifick\u00fdch protil\u00e1tok v likvore<\/strong><\/p>\n<p>Protil\u00e1tkov\u00fd index (AI, antibody index) predstavuje ur\u010dit\u00fa intratek\u00e1lne syntetizovan\u00fa frakciu \u0161pecifick\u00fdch protil\u00e1tok v likvore. Je dan\u00fd pomerom kvocientu \u00a0pr\u00edslu\u0161nej \u0161pecifickej protil\u00e1tky Q\u0161pecIg a kvocientu celkov\u00e9ho pr\u00edslu\u0161n\u00e9ho imunoglobul\u00ednu QIg.<\/p>\n<p><strong>Interpret\u00e1cia patologickej hodnoty AI \u2265 1,5:<\/strong><\/p>\n<ul>\n<li>d\u00f4kaz intratek\u00e1lnej synt\u00e9zy protil\u00e1tok proti etiologick\u00e9mu \u00a0antig\u00e9nu<\/li>\n<li>d\u00f4kaz sekund\u00e1rnej poly\u0161pecifickej imunitnej reakcie bez pr\u00edtomnosti dan\u00e9ho antig\u00e9nu alebo bez klinick\u00fdch pr\u00edznakov pr\u00edslu\u0161nej infekcie Oligoklonalita IgG je v\u00fdsledkom poly\u0161pecifickej imunitnej odpovede s mno\u017estvom protil\u00e1tok. Tieto protil\u00e1tky s\u00fa namieren\u00e9 proti r\u00f4znym antig\u00e9nom ako v\u00edrusy, bakt\u00e9rie, vlastn\u00e9 autoantig\u00e9ny neur\u00f3nov alebo oligodendrocytov a in\u00e9 (tabu\u013eka 6).<\/li>\n<\/ul>\n<p>MRZ-reakcia predstavuje intratek\u00e1lnu synt\u00e9zu IgG proti v\u00edrusom os\u00fdpok (Measles), rubeoly (Rubella) a varicely zoster (VZV). Ide o tzv. sekund\u00e1rnu poly\u0161pecifick\u00fa \u00a0protil\u00e1tkov\u00fa reakciu. T\u00e1to reakcia podporuje chronick\u00fd z\u00e1palov\u00fd proces v CNS autoimunitnej gen\u00e9zy. Naopak, vylu\u010duje ak\u00fatne infek\u010dn\u00e9 ochorenie nervov\u00e9ho syst\u00e9mu. Jej patofyziol\u00f3gia nie je dosia\u013e objasnen\u00e1. MRZ-reakcia je tvorba poly- \u0161pecifick\u00fdch protil\u00e1tok indukovan\u00e1 ur\u010dit\u00fdm antig\u00e9nom (v\u00edrusy, bakt\u00e9rie), ktor\u00e9 n\u00e1sledne skr\u00ed\u017eene reaguj\u00fa s neuron\u00e1lnymi antig\u00e9nmi. Protil\u00e1tkov\u00e1 odpove\u010f \u00a0v CNS pretrv\u00e1va, aj ke\u010f pr\u00edslu\u0161n\u00fd antig\u00e9n ch\u00fdba. Uveden\u00fd fenom\u00e9n je odrazom dlhodob\u00e9ho z\u00e1palu (4).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Pozitivita MRZ-reakcie:<\/strong><\/p>\n<ul>\n<li>sclerosis multiplex (\u0161pecificita 84 \u2013 94 %)<\/li>\n<li>syst\u00e9mov\u00e9 autoimunitn\u00e9 ochorenia postihuj\u00face CNS (SLE, Sj\u00f6grenov syndr\u00f3m, syst\u00e9mov\u00e9 \u00a0vaskulit\u00eddy, reumatoidn\u00e1 \u00a0artrit\u00edda, antifosfolipi- dov\u00fd syndr\u00f3m)<\/li>\n<\/ul>\n<p><strong><br \/>\nHerpetick\u00e9 v\u00edrusy a nervov\u00fd syst\u00e9m<\/strong><\/p>\n<p>Charakteristickou \u00a0vlastnos\u0165ou \u00a0herpetick\u00fdch \u00a0v\u00edrusov je schopnos\u0165 latentnej infekcie, najm\u00e4 v gangli\u00e1ch \u00a0nervov\u00e9ho \u00a0syst\u00e9mu \u00a0(HSV, VZV), v B-lymfocytoch (EBV), v monocytoch (CMV), v epitelov\u00fdch bunk\u00e1ch (CMV) i v bunk\u00e1ch kostnej drene. Po oslaben\u00ed imunity m\u00f4\u017ee d\u00f4js\u0165 k ich reaktiv\u00e1cii. V\u00e4\u010d\u0161ina herpetick\u00fdch v\u00edrusov je neurotropn\u00e1. Pod\u013ea lokaliz\u00e1cie patologick\u00e9ho procesu m\u00f4\u017eu sp\u00f4sobova\u0165 meningit\u00eddy, encefalit\u00eddy, myelit\u00eddy, radikulit\u00eddy, neurit\u00eddy a in\u00e9 z\u00e1palov\u00e9 ochorenia nervov\u00e9ho syst\u00e9mu (tabu\u013eka 7).<\/p>\n<p>\u010cast\u00e9 v\u00edrusov\u00e9 infekcie v kombin\u00e1cii r\u00f4znych faktorov p\u00f4sobiacich v dlh\u0161om \u010dasovom obdob\u00ed (ako genetick\u00e1 predispoz\u00edcia, pohlavie, vek, horm\u00f3ny, lieky) m\u00f4\u017eu vies\u0165 a\u017e k strate tolerancie k vyvol\u00e1vaj\u00facemu \u00a0agens a n\u00e1sledne sp\u00f4sobi\u0165 vznik mnoh\u00fdch autoimunitn\u00fdch ochoren\u00ed (syst\u00e9mov\u00fdch i org\u00e1novo\u0161pecifick\u00fdch). O v\u00edrusoch je zn\u00e1me, \u017ee mechanizmom molekulov\u00e9ho mimikry indukuj\u00fa rozvoj imunopatologick\u00fdch procesov. Bola dok\u00e1zan\u00e1 zhoda v sekvencii aminokysel\u00edn (poz\u00edcia 84 \u2013 101) myel\u00ednov\u00e9ho b\u00e1zick\u00e9ho prote\u00ednu (MBP) a sekvenciami prote\u00ednov os\u00fdpok, CMV, EBV, hum\u00e1nneho herpetick\u00e9ho v\u00edrusu 6 alebo 7, hemaglutin\u00ednu \u00a0v\u00edrusu chr\u00edpky, polymer\u00e1zy HBV a koronav\u00edrusov (7).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>EBV a sclerosis multiplex<\/strong><\/p>\n<p>Sclerosis multiplex (SM) je z\u00e1va\u017en\u00e9 chronick\u00e9 demyeliniza\u010dn\u00e9 ochorenie CNS autoimunitn\u00e9ho charakteru, charakterizovan\u00e9 de\u0161trukciou myel\u00ednov\u00fdch obalov nervov\u00fdch vl\u00e1kien s postupnou stratou oligodendrocytov a ax\u00f3nov. Presn\u00e1 pr\u00ed\u010dina vzniku ochorenia nie je zn\u00e1ma. Diagnostika SM je zlo\u017eit\u00fd proces. Mus\u00ed sp\u013a\u0148a\u0165 mnoh\u00e9 stanoven\u00e9 krit\u00e9ri\u00e1, pri\u010dom je ve\u013emi d\u00f4le\u017eit\u00fd likvorov\u00fd n\u00e1lez (tabu\u013eka 8).<br \/>\nV posledn\u00fdch rokoch sa objavili \u0161t\u00fadie, ktor\u00e9 upozor\u0148uj\u00fa\u00a0 na mo\u017en\u00fa d\u00f4le\u017eit\u00fa \u00falohu EBV v patogen\u00e9ze SM. U pacientov bola zaznamenan\u00e1 pr\u00edtomnos\u0165 oligoklonov\u00fdch \u00a0IgG gradientov so \u0161pecificitou pre EBNA1. Viac ako 95 % pacientov \u00a0so SM vykazovalo s\u00e9ropozitivitu protil\u00e1tok proti EBNA-1 (8).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Likvorea<\/strong><\/p>\n<p>Likvor vytekaj\u00faci zo subarachnoid\u00e1lneho \u00a0priestoru do nosov\u00fdch a u\u0161n\u00fdch dut\u00edn je ve\u013ek\u00fdm rizikom vzniku bakteri\u00e1lnych meningit\u00edd a mozgov\u00e9ho abscesu. Identifik\u00e1cia likvorey je zalo\u017een\u00e1 \u00a0na d\u00f4kaze bielkov\u00edn typick\u00fdch\u00a0 pre likvor, v s\u00fa\u010dasnosti najm\u00e4 desialyzovanej formy transfer\u00ednu (\u03b22-transfer\u00edn, tzv. asialotransfer\u00edn).<br \/>\nV likvore s\u00fa pr\u00edtomn\u00e9 \u00a0dve izoformy transfer\u00ednu. \u03b21-transfer\u00edn je z\u00e1palov\u00fd marker, do likvoru sa pravdepodobne \u00a0dost\u00e1va pomocou \u00a0\u0161pecifick\u00e9ho transportn\u00e9ho syst\u00e9mu, ktor\u00fd sa nach\u00e1dza v bari\u00e9rov\u00fdch syst\u00e9moch mozgu. Zv\u00fd\u0161en\u00e9 koncentr\u00e1cie \u03b21-transfer\u00ednu nach\u00e1dzame \u00a0pri v\u0161etk\u00fdch neuroinfekci\u00e1ch. V CNS doch\u00e1dza \u00a0k od\u0161tiepeniu zvy\u0161kov kyseliny sialovej p\u00f4soben\u00edm neuroaminid\u00e1zy a vzniku asialotransfer\u00ednu, t. j. \u03b22-transfer\u00ednu. T\u00e1to izoforma transfer\u00ednu je \u0161pecifick\u00e1 v\u00fdlu\u010dne pre likvor (9).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>P<\/strong><strong>r<\/strong><strong>e<\/strong><strong>d<\/strong><strong>an<\/strong><strong>a<\/strong><strong>l<\/strong><strong>y<\/strong><strong>t<\/strong><strong>i<\/strong><strong>c<\/strong><strong>k<\/strong><strong>\u00e1 f\u00e1za<\/strong><\/p>\n<p><strong>Cytol\u00f3gia \u00a0likvoru:<\/strong> likvor treba \u00a0transportova\u0165 \u00a0v chlade \u00a0(pri 2 \u2013 8 OC), doru\u010di\u0165 do laborat\u00f3ria maxim\u00e1lne do 2 hod\u00edn po LP.<\/p>\n<p><strong>\u0160peci\u00e1lne vy\u0161etrenia:<\/strong> likvor (4 ml) a sk\u00famavka zrazenej krvi (odber do sk\u00famavky s g\u00e9lom).<\/p>\n<p><strong>Likvorea:<\/strong> sekr\u00e9t z nosa, z ucha (minim\u00e1lne 0,100 ml) a sk\u00famavka zrazenej krvi (odber do sk\u00famavky s g\u00e9lom).<br \/>\n<em>P<\/em><em>o<\/em><em>zn\u00e1mka: Dlh\u0161\u00edm st\u00e1t\u00edm likvoru <\/em><em>pri izbovej teplote doch\u00e1dza k zmene koncentr\u00e1ci\u00ed niektor\u00fdch parametrov. Kles\u00e1 koncentr\u00e1cia gluk\u00f3zy, st\u00fapa koncentr\u00e1cia lakt\u00e1tu, doch\u00e1dza k rozpadu buniek (likvor na cytologick\u00e9 vy\u0161etrenie je preto nutn\u00e9 spracova\u0165 do 3 hod\u00edn po vykonan\u00ed LP).\u00a0<\/em><em>P<\/em><em>r<\/em><em>i transporte vzoriek <\/em><em>na v\u00e4\u010d\u0161iu vzdialenos\u0165 je potrebn\u00e9 likvor, sekr\u00e9t a s\u00e9rum (pozor nie pln\u00fa krv !!!) uchov\u00e1va\u0165 v chlade a n\u00e1sledne \u010do v najkrat\u0161om\u00a0\u010dase doru\u010di\u0165 do laborat\u00f3ria.<\/em><\/p>\n<p>&nbsp;<\/p>\n<p><strong>I<\/strong><strong>n<\/strong><strong>dik<\/strong><strong>a<\/strong><strong>\u010d<\/strong><strong>n<\/strong><strong>\u00e9 obmedzenia<\/strong><\/p>\n<p>Neurol\u00f3gia \u00a0(004), pediatrick\u00e1 \u00a0neurol\u00f3gia \u00a0(104), infektol\u00f3gia \u00a0(002), pediatrick\u00e1 infektol\u00f3gia (331) Likvorea \u2013 neurochirurgia (037) a otorinolaryngol\u00f3gia (014)<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Dos<\/strong><strong>t<\/strong><strong>up<\/strong><strong>nos<\/strong><strong>\u0165 vy\u0161etrenia<\/strong><\/p>\n<p>Centr\u00e1lne laborat\u00f3rium Ko\u0161ice<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Z<\/strong><strong>\u00e1<\/strong><strong>ver<\/strong><\/p>\n<p>Vy\u0161etrenie likvoru umo\u017e\u0148uje zachyti\u0165 a n\u00e1sledne charakterizova\u0165 patologick\u00fd proces prebiehaj\u00faci v nervovom syst\u00e9me. Aj ke\u010f v niektor\u00fdch pr\u00edpadoch je diagnostika neurologick\u00fdch ochoren\u00ed, najm\u00e4 autoimunitn\u00e9ho p\u00f4vodu zlo\u017eit\u00e1, pri interpret\u00e1cii dosiahnut\u00fdch \u00a0laborat\u00f3rnych v\u00fdsledkov netreba zab\u00fada\u0165 na mo\u017enos\u0165 \u00a0bli\u017e\u0161ej spolupr\u00e1ce medzi laborat\u00f3rnymi diagnostikmi a lek\u00e1rmi.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>L<\/strong><strong>it<\/strong><strong>e<\/strong><strong>ra<\/strong><strong>t<\/strong><strong>\u00fa<\/strong><strong>ra<\/strong><\/p>\n<ol>\n<li>Duniewicz M, Adam P, et al. <em>N<\/em><em>eu<\/em><em>r<\/em><em>oi<\/em><em>nfekce. <\/em>1. vyd. Praha: Maxdorf; 1999: 309.<\/li>\n<li>Reiber H, Felgenhauer K. Protein \u00a0transfer at the blood-CSF \u00a0barrier and the quantitation of the humoral immune response within the central nervous system. <em>Clin. <\/em><em>Chim.Acta.\u00a0<\/em>1987;163:319\u2013328.<\/li>\n<\/ol>\n<ol start=\"3\">\n<li>Reiber H, Peter JB. Cerebrospinal fluid analysis: diseaserelated data patterns and evaluation programs. <em>J<\/em><em>. NeurSci. <\/em>2001;1:101\u2013122.<\/li>\n<li>Reiber H, Ungefehr S, Jacobi Ch. The intrathecal, polyspecific and oligoclonal immune response in multiple sclerosis. <em>Mul<\/em><em>tiple Sclerosis. <\/em>1998;4:111\u2013117.<\/li>\n<\/ol>\n<ol start=\"5\">\n<li>Havrdov\u00e1 E, Racek P, Jedli\u010dka P. Vztah intrathek\u00e1ln\u00ed produkce IgG v\u010detn\u011b podt\u0159\u00edd IgG k hladin\u00e1m cytokinu v mozkom\u00ed\u0161n\u00edm moku pacient\u016f se sclerosis multiplex. <em>K<\/em><em>lin<\/em><em>. <\/em><em>Bi<\/em><em>o<\/em><em>chem.Meta\u00a0<\/em>1998;6(27)4:226\u2013229.<\/li>\n<\/ol>\n<ol start=\"6\">\n<li>Gilden DH, Mahallingam R, Cohrs RJ, Tyler KL. Herpesvirus \u00a0infections \u00a0of the nervous sys- tem. <em>Natu<\/em><em>r<\/em><em>e Clinical Practice Neurology. <\/em>2007;3(2).<\/li>\n<li>Buc M. <em>Autoimunita <\/em><em>a autoimunitn\u00e9 choroby. <\/em>1. vyd. Bratislava: VEDA; 2005: 500.<\/li>\n<li>Santiago O, et al. Relation between Epstein-Barr virus and multiple sclerosis: analytic study of scientific production. <em>E<\/em><em>u<\/em><em>r<\/em><em>. <\/em><em>J<\/em><em>. Clin. Microbiol.Infect.Dis. <\/em>2010;29(7):857\u2013866.<\/li>\n<li>Rouah E, et al. Transferrin analysis by immunofixation as an aid in the diagnosis of cerebrospinal fluid otorrhea<em>. <\/em><em>I<\/em><em>n Arch. Pathol.Lab.Med. <\/em>1987;111:756\u2013757.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper. \u00a0 &nbsp; \u00davod Z\u00e1kladn\u00e9 biochemick\u00e9 a cytologick\u00e9 \u00a0vy\u0161etrenie likvoru tvor\u00ed z\u00e1klad \u0161tandardnej diagnostiky ak\u00fatnych ochoren\u00ed postihuj\u00facich \u00a0nervov\u00fd syst\u00e9m, preto\u017ee poskytuje cenn\u00e9 vstupn\u00e9 inform\u00e1cie o mo\u017enom charaktere ochorenia. Vyu\u017eit\u00edm vysokocitliv\u00fdch imunochemick\u00fdch<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[289],"tags":[667,666,664,668,669,665,672,670,671,663],"class_list":["post-1078","post","type-post","status-publish","format-standard","hentry","category-biochemistry","tag-blood-csf-barrier","tag-cytology-of-csf","tag-glucose","tag-intrathecal-oligoclonal-immunoglobulin-synthesis","tag-isoelectric-focusing","tag-lactate","tag-liquorrhoea","tag-mrz-reaction","tag-neurotropic-viruses","tag-proteins","typ_clanku-review-article"],"acf":{"abstrakt":"<p>Cerebrospinal fluid (CSF) analysis has significant and essential place in neurology and neurosurgery. Information obtained from the analysis of this precious biological material provides great contribution in diagnosis of central and peripheral nervous system diseases. Analysing of CSF may help distinguish the type of inflammation (bacterial, viral, autoimmune), diagnose subarachnoid bleeding, tumor processes in CNS and neurodegenerative diseases.<\/p>\n<p><strong>Key words:\u00a0<\/strong>proteins, glucose, lactate, cytology of CSF, blood-CSF barrier, intrathecal oligoclonal immunoglobulin synthesis, isoelectric focusing, MRZ reaction, neurotropic viruses, liquorrhoea<\/p>\n","casopis":[{"ID":995,"post_author":"7","post_date":"2016-11-16 12:14:30","post_date_gmt":"2016-11-16 11:14:30","post_content":"<h4><strong>Biochemistry <\/strong><\/h4>\r\n<ul>\r\n \t<li>Biochemical inflammation markers<\/li>\r\n \t<li>Biochemical examinations in liver diseases<\/li>\r\n \t<li>Biochemical diagnosis in diseases of GIT<\/li>\r\n \t<li>Hypoglycemia<\/li>\r\n \t<li>Urolithiasis as a result of metabolic diseases<\/li>\r\n \t<li>Indication and application of tumor markers in clinical practice<\/li>\r\n \t<li>Monoclonal gammopathies \u2013 laboratory examinations in diagnosis and monitoring<\/li>\r\n \t<li>Hormones in diagnosis of reproductive function disorders<\/li>\r\n \t<li>Cerebrospinal fluid diagnosis of diseases affecting the nervous system<\/li>\r\n \t<li>Determining trace elements in blood serum<\/li>\r\n<\/ul>\r\n<h4><strong>Genetics<\/strong><\/h4>\r\n<ul>\r\n \t<li>Assessing the therapeutic response in patients with chronic myelocyte leukemia treated with tyrosine kinase inhibitors<\/li>\r\n \t<li>Hormones in diagnosis of reproductive functions\u2019 disorders<\/li>\r\n<\/ul>\r\n<h4><strong>Hematology <\/strong><\/h4>\r\n<ul>\r\n \t<li>Anemias \u2013 laboratory diagnosis of the most frequently prevalent types of anemia<\/li>\r\n \t<li>Laboratory and hematological technical equipment<\/li>\r\n<\/ul>\r\n<h4><strong>Immunology <\/strong><\/h4>\r\n<ul>\r\n \t<li>Paraneoplastic neurological syndromes and in vitro diagnosis of onconeural antibodies<\/li>\r\n<\/ul>","post_title":"newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab","to_ping":"","pinged":"","post_modified":"2017-08-16 21:40:20","post_modified_gmt":"2017-08-16 19:40:20","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"12","upload_clanok":{"ID":1079,"id":1079,"title":"bertova_likvorova_diagnostika","filename":"Bertov\u00e1_Likvorov\u00e1_diagnostika.pdf","filesize":200928,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2016\/12\/Bertov\u00e1_Likvorov\u00e1_diagnostika.pdf","link":"https:\/\/www.newslab.sk\/en\/cerebrospinal-fluid-diagnosis-of-diseases-affecting-the-nervous-system\/bertova_likvorova_diagnostika\/","alt":"","author":"7","description":"","caption":"","name":"bertova_likvorova_diagnostika","status":"inherit","uploaded_to":1078,"date":"2016-12-08 20:34:31","modified":"2016-12-08 20:34:31","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1078","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1078"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1078\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1078"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1078"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1078"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}