シンポジウム１５‐５　特発性正常圧水頭症（ｉＮＰＨ）：病態研究最近の進歩　特発性正常圧水頭症病態研究：最近の進歩～特発性正常圧水頭症の髄液診断について

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Object: Cerebrospinal fluid (CSF) shunting can improve symptoms of elderly patients idiopathic normal pressure hydrocephalus (iNPH). However, adjunctive means for confirming the diagnosis remain unavailable. We have previously reported specific increase of leucine-rich alpha-2-glycoprotein (LRG) in iNPH CSF, and present study investigates its potential clinical applications. Methods: We performed CSF tap test (TT) on 90 patients and shunting in 52 patients (mean age 73.5 years), evaluating symptom improvement and higher cerebral functions-MMSE and Frontal Assessment Battery (FAB) before and twelve months after shunting. LRG and tau protein concentrations in TT CSF were simultaneously measured using ELIZA. Then we compared the predictive value of these concentrations with TT results regarding successful shunting outcomes. Findings: Positive combinations of TT and LRG concentrations of 67ng/mL or higher, gave 81.6% sensitivity and 78.6% specificity. Therefore we used LRG (67ng/mL) and tau (200pg/mL) cutoff values, LRG≥67ng/ml and tau<200pg/ml, 31 of 34 patients (91.2%) had a positive TT and all operated 22 patients were shunt responders. Dementia MMSE and FAB scores in them increased from a baseline of 22.05 to 25.65 and 11.38 to 13.08respectively. Conclusions: A combination of positive TT and biomarkers quantification such as LRG and tau protein, can reliably predict shunting outcome in iNPH patients.
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