Background The cerebrospinal fluid (CSF)/serum quotient of albumin (QAlb) is the most used biomarker for the evaluation of blood–cerebrospinal fluid barrier (B-CSF-B) permeability. For years QAlb was considered only as an age-related parameter but recently it has also been associated to sex. The aim of the present study was to explore the impact of sex in the determination of B-CSF-B dysfunction. Methods The analysis was retrospectively conducted on subjects consecutively admitted to the neurological ward. CSF and serum albumin levels were measured by immunonephelometry and pathological QAlb thresholds were considered: 6.5 under 40 years, 8.0 in the age 40–60 and 9.0 over 60 years. Results 1209 subjects were included in the study. 718 females and 491 males (age: 15–88 years): 24.6% of patients had a diagnosis of multiple sclerosis, 23.2% suffered from other inflammatory neurological diseases, 24.6% were affected by non-inflammatory neurological diseases, and for 27.6% of patients the final neurological diagnosis could not be traced. Dysfunctional B-CSF-B was detected more frequently (44 vs. 20.1%, p < 0.0001) and median QAlb value were higher (7.18 vs. 4.87, p < 0.0001) in males than in females in the overall study population and in all disease subgroups. QAlb and age were positively correlated both in female (p < 0.0001) and male (p < 0.0001) patients, however the slopes of the two regression lines were not significantly different (p = 0.7149), while the difference between the elevations was extremely significant (p < 0.0001) with a gap of 2.2 units between the two sexes. Finally, in a multivariable linear regression analysis increased age and male sex were independently associated with higher QAlb in the overall study population (both p < 0.001) and after stratification by age and disease group. Conclusions Accordingly, identification and validation of sex-targeted QAlb thresholds should be considered as a novel tool in an effort to achieve more precision in the medical approach.

中文翻译：

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使用白蛋白商数，年龄和男性的增加与血脑脊液屏障功能障碍的发生频率较高独立相关

背景 脑脊液 (CSF)/白蛋白血清商 (QAlb) 是评估血脑脊液屏障 (B-CSF-B) 通透性最常用的生物标志物。多年来，QAlb 仅被视为与年龄相关的参数，但最近它也与性别有关。本研究的目的是探讨性别在确定 B-CSF-B 功能障碍中的影响。方法对连续入院神经病房的受试者进行回顾性分析。通过免疫比浊法测量脑脊液和血清白蛋白水平，并考虑病理 QAlb 阈值：40 岁以下 6.5，40-60 岁为 8.0，60 岁以上为 9.0。结果 1209 名受试者被纳入研究。718 名女性和 491 名男性（年龄：15-88 岁）：24.6% 的患者被诊断为多发性硬化症，23。2% 患有其他炎症性神经系统疾病，24.6% 受非炎症性神经系统疾病影响，27.6% 的患者无法追踪最终的神经系统诊断。在整个研究人群和所有研究人群中，男性的功能障碍 B-CSF-B 检测频率更高（44 对 20.1%，p < 0.0001）并且中位 QAlb 值更高（7.18 对 4.87，p < 0.0001）疾病亚组。QAlb 和年龄在女性（p < 0.0001）和男性（p < 0.0001）患者中均呈正相关，但两条回归线的斜率没有显着差异（p = 0.7149），而升高之间的差异非常显着(p < 0.0001) 两性之间的差距为 2.2 个单位。最后，在多变量线性回归分析中，年龄和男性的增加与整个研究人群中较高的 QAlb 独立相关（均 p < 0.001），并且在按年龄和疾病组进行分层后。结论 因此，应将性别目标 QAlb 阈值的识别和验证视为一种新工具，以努力在医疗方法中实现更高的精确度。