The Reibergram in neurological diseases of dogs
In various neurological diseases the total protein content in cerebrospinal
fluid (CSF) might be increased. To distinguish blood-CSF barrier
dysfunction (BD) and intrathecal immunoglobulin (Ig) synthesis (ITS)
albumin, mainly produced extracranially, can be used as a reference
marker for BD. But hitherto used linear regression models are insufficient
in detecting ITS or BD. In the present study a hyperbolic quotient
graph (=“Reibergram”) was developed based on albumin
CSF/serum quotients (QAlb) and IgA CSF/serum quotients (QIgA)
from 6 healthy Beagles and 38 client-owned dogs with diseases in
which an isolated BD was suspected. Quantile regression resulted in
the hyperbolic curve, QLim (IgA)= 0.13 √((QAlb) 2+11.9.10-6) –
1.01.10-3, where QLim (IgA) describes the upper limit of physiological
value of QIgA. The upper physiological value of QAlb was calculated
with a 95% confidence interval and is 2.22. Both lines QAlb and QLim
(IgA) were transferred into a graph, where they divide the diagram
into four sections: normal, isolated BD, isolated ITS of IgA and combined
BD & ITS of IgA. The canine Reibergram was validated with
118 dogs suffering from various neurological diseases and detects diseases
with suspected BD with a sensitivity and specificity of 81% and
89% respectively, and diseases with suspected ITS of IgA with a sensitivity
of 85% and specificity of 88%. The canine IgA Reibergram
allows the clinician to draw conclusions about the function of the
blood-CSF barrier and ITS of IgA and might aid as an additional tool in
the diagnostics of neurological diseases in dogs.
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