{"id":116423,"date":"2014-03-10T00:00:00","date_gmt":"2014-03-10T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/el-reibergrama-en-el-analisis-del-la%c2%adquido-cefalorraqua%c2%addeo-y-el-diagnostico-de-esclerosis-multiple\/"},"modified":"2014-03-10T00:00:00","modified_gmt":"2014-03-10T00:00:00","slug":"el-reibergrama-en-el-analisis-del-la%c2%adquido-cefalorraqua%c2%addeo-y-el-diagnostico-de-esclerosis-multiple","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/neurologia\/el-reibergrama-en-el-analisis-del-la%c2%adquido-cefalorraqua%c2%addeo-y-el-diagnostico-de-esclerosis-multiple\/","title":{"rendered":"El reibergrama en el an\u00e1lisis del l\u00edquido cefalorraqu\u00eddeo y el diagn\u00f3stico de esclerosis m\u00faltiple"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Ines Mar\u00eda Luna Calca\u00f1o <\/strong><\/h2>\n<p>Objetivo:  conocer la utilidad diagn\u00f3stica del reibergrama, en la determinaci\u00f3n de s\u00edntesis intratecal de igg en pacientes sospechosos de esclerosis m\u00faltiple, contrast\u00e1ndolo con otras pruebas complementarias utilizadas para el diagn\u00f3stico de esclerosis m\u00faltiple en t\u00e9rminos de sensibilidad, especificidad y valor predictivo positivo. pacientes y m\u00e9todo:  se ha realizado un estudio retrospectivo, descriptivo, epidemiol\u00f3gico y de corte transversal en el per\u00edodo comprendido entre  abril 2009 y abril 2013 en el hospital universitario rafael m\u00e9ndez con las muestras de l\u00edquido cefalorraqu\u00eddeo de 128 pacientes del servicio de neurolog\u00eda a los que se le pidieron bandas oligoclonales, como criterio de sospecha de esclerosis m\u00faltiple, a los fines de comparar las mismas con el reibergrama, la rmn y el \u00edndice de link en el diagnostico de esclerosis m\u00faltiple. Los reibergramas fueron construidos con el software protein statistic in csf analysis with reibergrams, version 4.17 y el an\u00e1lisis estad\u00edstico fue realizado con el software g-stat 2.0.1. resultados:  -de los 128 pacientes estudiados 40 tuvieron un diagn\u00f3stico final de esclerosis m\u00faltiple recurrente-remitente (emrr), para 31,25%  y 1 tuvo el diagn\u00f3stico final de esclerosis m\u00faltiple primaria progresiva  (empp) para un 0,78%. -de los 41 pacientes con esclerosis m\u00faltiple 28 tuvieron bandas oligoclonales positivas para un 21,87% de la serie, 13 pacientes tuvieron bandas oligoclonales negativas para un 10,16%. -las bandas oligoclonales muestran en esta serie una sensibilidad de 68,29% y una especificidad de 90,80%, con un valor predictivo positivo de 88,13% para diagnosticar esclerosis m\u00faltiple en esta serie de pacientes, con una likelihood ratio de 7,42 con ic al 95%, y or = 21,27 con ic al 95%, y un valor de p=&lt;0,0001. -de los 41 pacientes con esclerosis m\u00faltiple 39 tuvieron reibergrama positivo  para un 30,47% de la serie, 2 pacientes tuvieron reibergrama negativo  para un 1,56%. -el reibergrama muestra en esta serie una sensibilidad de 95,12% y una especificidad de 96,55%, con un valor predictivo positivo de 96,50% para diagnosticar esclerosis m\u00faltiple en esta serie de pacientes, con un likelihood ratio de 27,58 con ic al 95%, y or = 546,0 con ic al 95%, y un valor de p=&lt;0,0001. conclusiones: 1.-  El reibergrama aporta mayor utilidad diagn\u00f3stica que las bandas oligoclonales (boc) en el estudio del lcr al determinar s\u00edntesis intratecal de igg  en pacientes con esclerosis m\u00faltiple en esta serie, en t\u00e9rminos de mayor sensibilidad, especificidad, valor predictivo positivo y menos falsos negativos.  2.- La prueba complementaria &quot;princeps&quot; para el diagnostico de esclerosis multiple en nuestra serie es la rmn, con una sensibilidad, especificidad y valor predictivo positivo mas altos que el resto de pruebas estudiadas. 3.-  En esta serie el reibergrama como prueba complementaria del lcr se correlaciona m\u00e1s con el diagnostico cl\u00ednico de esclerosis m\u00faltiple que con las bandas oligoclonales (boc), as\u00ed como tambi\u00e9n las boc se correlacionan m\u00e1s con el diagn\u00f3stico que con el reibergrama. Ambas pruebas se correlacionan muy poco entre s\u00ed.  4.-El \u00edndice de link en nuestra serie, aporta resultados similares a los de las bandas oligoclonales (boc) en cuanto a sensibilidad, sin embargo se relaciona mejor con el reibergrama que con las boc, con el que comparte similitudes en t\u00e9rminos de especificidad y valor predictivo positivo, aunque presenta mas falsos negativos que el reibergrama y  que las bandas oligoclonales (boc). 5.- El reibergrama se correlaciona positivamente y en mayor medida con el diagn\u00f3stico de em, que el resto de pruebas del lcr estudiadas en esta serie.    objective:  meet the diagnostic  utility of reibergram, in determining intrathecal igg synthesis in patients suspected of multiple sclerosis, contrasting it with other tests used for the diagnosis of multiple sclerosis in terms of sensitivity, specificity and positive predictive value.  patients and methods:  we performed a retrospective, descriptive, cross-sectional epidemiological study in the period between april 2009 and april 2013 at the hospital rafael m\u00e9ndez with cerebrospinal fluid samples from 128 patients at the neurology those who asked  oligoclonal bands, as criteria of suspected multiple sclerosis, in order to compare them with reibergram, mri and link index in the diagnosis of multiple sclerosis. The reibergrams were built with statistic in csf protein analysis with reibergrams software, version 4.17 and statistical analysis was performed with g-stat 2.0.1 software.  results:  -of the 128 patients studied 40  had a final diagnosis of relapsing-remitting multiple sclerosis (rrms), to 31.25%, and 1 had a final diagnosis of primary progressive (ppms) ms to 0.78%.  -of the 41 patients with multiple sclerosis, 28 had positive oligoclonal bands for 21.87% of the series, 13 patients had negative oligoclonal bands to 10.16%.  -oligoclonal bands in this series show a sensitivity of 68.29% and a specificity of 90.80%, with a positive predictive value of 88.13% for diagnosing multiple sclerosis in this series of patients, with a likelihood ratio of 7 , 42 with 95% ci and or = 21.27 with 95% ci, and p value &lt;0.0001.  -of the 41 patients with multiple sclerosis 39 were positive for 30.47% reibergram series, 2 patients had negative reibergram to 1.56%.  -the reibergram shown in this series a sensitivity of 95.12% and a specificity of 96.55%, with a positive predictive value of 96.50% for diagnosing multiple sclerosis in this series of patients, with a likelihood ratio of 27, 58 with 95% ci and or = 546.0 with 95% ci, and p value &lt;0.0001.  conclusions:  the conclusions that can be drawn in this study are listed below:  1 -. Reibergram provides the highest diagnostic utility that oligoclonal bands (ocb) in csf samples to determine intrathecal igg synthesis in multiple sclerosis patients in this series, in terms of increased sensitivity, specificity, positive predictive value and fewer false negative.  . 2 &#8211; in this series as a complementary  cerebrospinal ( csf )fluid test , reibergram correlates more with the clinical diagnosis of multiple sclerosis than oligoclonal bands (ocb) and ocb also correlate more with the diagnosis than reibergram. Both tests correlate very little with each other.  . 3 &#8211; the reibergram correlates  more positively with the diagnosis of ms,  intead others csf tests studied in this series.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>El reibergrama en el an\u00e1lisis del l\u00edquido cefalorraqu\u00eddeo y el diagn\u00f3stico de esclerosis m\u00faltiple<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 El reibergrama en el an\u00e1lisis del l\u00edquido cefalorraqu\u00eddeo y el diagn\u00f3stico de esclerosis m\u00faltiple <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Ines Mar\u00eda Luna Calca\u00f1o <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 03\/10\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Juan  Jose Gomariz Garcia<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Jos\u00e9 javier Mart\u00edn fern\u00e1ndez <\/li>\n<li>Jos\u00e9 joaqu\u00edn Hern\u00e1ndez roca (vocal)<\/li>\n<li>Antonio Mart\u00ednez pastor (vocal)<\/li>\n<li>guillermo Parrilla reverter (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Ines Mar\u00eda Luna Calca\u00f1o Objetivo: conocer la utilidad diagn\u00f3stica del reibergrama, en la determinaci\u00f3n de s\u00edntesis intratecal [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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