各種神経疾患における髄液中β—glucuronidase，β2—microglobulin値の検討

THE CEREBROSPINAL FLUID CONCENTRATIONS OF β-GLUCURONIDASE AND β2-MICROGLOBULIN IN NEUROLOGICAL DISORDERS

　抄録　種々の神経疾患患者の髄液中β—glucuronidase （β—GL）およびβ2—rnicroglobulin （β₂—m）を測定し，各種神経疾患における測定値の検討と腫瘍マーカーとしての有用性，各種髄膜炎，特に感染性髄膜炎と癌性髄膜炎の鑑別における有用性等につき検討を加えた。対象は99例の神経疾患患者で，変性疾患群（6例），変形性頸椎症群（15例），ギランバレー症候群（8例），くも膜下出血群（6例），感染性髄膜炎群（21例），癌性髄膜炎群（9例），転移性硬膜外腫瘍群（10例），脳腫瘍群（24例）の8群に大別した。また13例の非神経疾患患者の髄液を正常対照としたがβ—GL，β₂—m値はそれぞれ122.5±10.8μg／dl／hr （Mean±SEM），0.99±0.15mg／lであった。髄液中β—GL値が有意に増加した群は，感染性髄膜炎群（266.7±65.5,P＜0.001），癌性髄膜炎群（249.0±54.5,P＜0.001），脳腫瘍群（216.0±470,P＜0.001）であった。しかし，感染性髄膜炎と癌性髄膜炎との間には有意差は認められず，腫瘍マーカーとしての有用性には乏しいと考えられた。ただし，髄膜浸潤を認める脳腫瘍例は著明に高値を示し，脳腫瘍の髄膜腔への拡がりを知る一つの手掛りとなりうると考えられた。髄液巾β₂—mは種々の神経疾患で増加がみられたが，腫瘍マーカーとしての有用性には乏しかった。

β-glucuronidase (β-GL) and β₂-microglobulin (β₂-m) of the cerebrospinal fluid (CSF) were as-sayed from the patients with various neurological diseases,in order to evaluate the difference of mean value of these enzyme activities in several groups of neurological diseases, diagnostic useful-ness for one of the central nervous system tumor markers, and the usefulness to differentiate carci-nomatous meningitis from infectious meningitides.

The subjects were 99 patients with various neu-rological diseases, and these were classified in the following eight diagnostic groups, central nervous system degenerative diseases (6 cases), cervical spondylotic radiculomyelopathy (15 cases), Guillain-Barre syndrome (8 cases), subarachnoid hemor-rhage secondary to ruptured aneurysm (6 cases), infectious meningitides (21 cases), carcinomatous meningitis (9 cases), metastatic extradural spinal cord tumors (10 cased) and brain tumors (24 cases). CSF was also obtained from 13 subjects without any known neurological diseases for β-GL and β₂-m as the normal control values.

β-GL and β₂-m were measured by Tsukamoto's method and the radioimmunoassay method (Phade-bas, β₂-m test) respectively. The statistical analyse were done by using the student t-test and expressed as p values.

In the normal control group of 13 individuals without any obvious neurological diseases, the mean values ± standard error of means (SEM) ofβ-GL and β₂-m were 122.5±10.8 ug/dl/hr, and 0.99±0.15 mg/l respectively.

Comparing to the normal control, the value of β-GL in CSF was significantly elevated in the groups with infectious meningitides (266.7±65.5, p<0.001),carcinomatous meningitis (249.0±54.5, p<0.001) and brain tumors (216.0±47.0, p<0.001) There was no significant difference in the concent-ration of β-GL between the infectious and the carcinomatous group.

In the brain tumor group, three patients with tumor cells in CSF cytology (two cases of glio-blastoma multiforme and one case of germinoma) revealed a significantly higher level of β-GL in CSF.

Therefore the elevation of β-GL in CSF was seen in infectious meningitides as well as carcino-matous meningitis and brain tumors and the sig-nificant elevation of β-GL was not useful for the diagnosis of CSF tumors. But marked elevation of β-GL might be an useful indicator for invasion and dissemination of the brain tumors to meninges and subarachnoid space.

The value of β₂-m was elevated in several groups such as cervical spondylotic radiculomyelo-pathy (1.47±0.16,p<O.001), infectious menigitides (4.87±0.61, p<0.001), carcinomatous meningitis (2.17±0.50, p<0.001) and brain tumors (2.69±0.50, p<0.001) significantly. Therefore it was concluded that β₂-in was not a useful marker for CNS tumors from the statistical point of views.