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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="review-article" dtd-version="1.2" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">Russian Journal of Infection and Immunity</journal-id><journal-title-group><journal-title xml:lang="en">Russian Journal of Infection and Immunity</journal-title><trans-title-group xml:lang="ru"><trans-title>Инфекция и иммунитет</trans-title></trans-title-group></journal-title-group><issn publication-format="print">2220-7619</issn><issn publication-format="electronic">2313-7398</issn><publisher><publisher-name xml:lang="en">SPb RAACI</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">17927</article-id><article-id pub-id-type="doi">10.15789/2220-7619-CSR-17927</article-id><article-categories><subj-group subj-group-type="toc-heading" xml:lang="en"><subject>REVIEWS</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="ru"><subject>ОБЗОРЫ</subject></subj-group><subj-group subj-group-type="article-type"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title xml:lang="en">CSF/serum ratios: modern approach to assess intrathecal response</article-title><trans-title-group xml:lang="ru"><trans-title>Ликвор-сывороточные индексы: современный подход к оценке интратекального воспаления</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Deomkina</surname><given-names>Alexandra M.</given-names></name><name xml:lang="ru"><surname>Демкина</surname><given-names>Александра Михайловна</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Assistant Professor, Department of Infectious Diseases in Children</p></bio><bio xml:lang="ru"><p>ассистент кафедры инфекционных болезней у детей</p></bio><email>sasha.deomkina@mail.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Sayfullin</surname><given-names>R. F.</given-names></name><name xml:lang="ru"><surname>Сайфуллин</surname><given-names>Р. Ф.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>PhD (Medicine), Associate Professor, Department of Infectious Diseases in Children</p></bio><bio xml:lang="ru"><p>к.м.н., доцент кафедры инфекционных болезней у детей</p></bio><email>sasha.deomkina@mail.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Shakaryan</surname><given-names>A. K.</given-names></name><name xml:lang="ru"><surname>Шакарян</surname><given-names>А. К.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Assistant Professor, Department of Infectious Diseases in Children, Researcher in the Clinical Department, Institute of Poliomyelitis</p></bio><bio xml:lang="ru"><p>ассистент кафедры инфекционных болезней у детей, научный сотрудник клинического отдела, Институт полиомиелита</p></bio><email>sasha.deomkina@mail.ru</email><xref ref-type="aff" rid="aff2"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Shamsheva</surname><given-names>O. V.</given-names></name><name xml:lang="ru"><surname>Шамшева</surname><given-names>О. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>DSc (Medicine), Professor, Head of the Department of Infectious Diseases in Children</p></bio><bio xml:lang="ru"><p>д.м.н., профессор, зав. кафедрой инфекционных болезней у детей</p></bio><email>sasha.deomkina@mail.ru</email><xref ref-type="aff" rid="aff4"/></contrib></contrib-group><aff-alternatives id="aff1"><aff><institution xml:lang="en">Pirogov Russian National Research Medical University</institution></aff><aff><institution xml:lang="ru">ФГАОУ ВО Российский национальный исследовательский медицинский университет имени Н.И. Пирогова Министерства здравоохранения РФ</institution></aff></aff-alternatives><aff-alternatives id="aff2"><aff><institution xml:lang="en">Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products of Russian Academy of Sciences</institution></aff><aff><institution xml:lang="ru">ФГАОУ ВО Российский национальный исследовательский медицинский университет имени Н.И. Пирогова Министерства здравоохранения РФ</institution></aff></aff-alternatives><aff-alternatives id="aff3"><aff><institution xml:lang="ru">ФГАНУ Федеральный научный центр исследований и разработки иммунобиологических препаратов им. М.П. Чумакова РАН</institution></aff><aff><institution xml:lang="en">Pirogov Russian National Research Medical University</institution></aff></aff-alternatives><aff id="aff4"><institution>ФГАОУ ВО Российский национальный исследовательский медицинский университет имени Н.И. Пирогова Министерства здравоохранения РФ</institution></aff><pub-date date-type="preprint" iso-8601-date="2025-06-16" publication-format="electronic"><day>16</day><month>06</month><year>2025</year></pub-date><pub-date date-type="pub" iso-8601-date="2025-11-06" publication-format="electronic"><day>06</day><month>11</month><year>2025</year></pub-date><volume>15</volume><issue>4</issue><issue-title xml:lang="en">Russian Journal of Infection and Immunity</issue-title><issue-title xml:lang="ru">Инфекция и иммунитет</issue-title><fpage>625</fpage><lpage>634</lpage><history><date date-type="received" iso-8601-date="2025-04-30"><day>30</day><month>04</month><year>2025</year></date><date date-type="accepted" iso-8601-date="2025-06-08"><day>08</day><month>06</month><year>2025</year></date></history><permissions><copyright-statement xml:lang="en">Copyright ©; 2025, Deomkina A.M., Sayfullin R.F., Shakaryan A.K., Shamsheva O.V.</copyright-statement><copyright-statement xml:lang="ru">Copyright ©; 2025, Демкина А.М., Сайфуллин Р.Ф., Шакарян А.К., Шамшева О.В.</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="en">Deomkina A.M., Sayfullin R.F., Shakaryan A.K., Shamsheva O.V.</copyright-holder><copyright-holder xml:lang="ru">Демкина А.М., Сайфуллин Р.Ф., Шакарян А.К., Шамшева О.В.</copyright-holder><ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/"/><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by/4.0</ali:license_ref></license></permissions><self-uri xlink:href="https://iimmun.ru/iimm/article/view/17927">https://iimmun.ru/iimm/article/view/17927</self-uri><abstract xml:lang="en"><p>CSF/serum ratios are the quotients of protein concentrations between the cerebrospinal fluid and blood serum. This method provides an objective assessment of proteins amount and origin in the cerebrospinal fluid. The cerebrospinal fluid protein composition consists of blood proteins passing through the blood-brain barrier and those synthesized within the central nervous system (intrathecally). Increased concentrations of proteins such as specific antibodies or autoantibodies in cerebrospinal fluid do not always mirror intrathecal synthesis or the presence of a pathological process in the intrathecal space. Elevated protein levels in the cerebrospinal fluid may be due to the higher blood protein influx through the blood-brain barrier. Quantification of CSF/Serum ratios according to German liquor specialist Hansotto Reiber allows distinguishing between blood and brain protein origin. This method is recognized as relevant for distinguishing between blood-derived and brain-derived protein fractions by the German Society for Liquor Diagnostics and Clinical Neurochemistry (Deutsche Gesellschaft für Liquordiagnostik und Klinische Neurochemie e.V.). The review is based on analyzing main literature databases (PubMed, CyberLeninka, Google Scholar, Scopus) and the latest publications on liquor diagnostics. Principles of CSF/Serum ratios, specific antibody indices calculation, and Reibergram structure are described. The classification of intrathecal inflammation and disease-related data patterns of immunoglobulin synthesis typical for diseases of the central and peripheral nervous system are presented. Thus, this literature review provides a detailed insight into the general principles of the modern approach for assessing cerebrospinal fluid protein composition and improves intrathecal humoral response comprehension. Additionally, the latest data on intrathecal immune response features in multiple sclerosis, neuromyelitis optica spectrum disorders, encephalitis associated with anti-MOG, anti-NMDAR antibodies, rheumatological diseases with CNS involvement, and neuroinfections are summarized.</p></abstract><trans-abstract xml:lang="ru"><p>Ликвор-сывороточные индексы — отношение одноименных белковых концентраций между спинномозговой жидкостью и сывороткой крови — метод, дающий объективную оценку количества и происхождения белка в ликворе. Белковый состав ликвора включает протеины, прошедшие из крови через гемато-энцефалический барьер, и синтезированные в пределах центральной нервной системы — интратекально. Выявление в цереброспинальной жидкости повышенных значений белков, таких как специфические антитела к инфекционным возбудителям или аутоантитела, не всегда соответствует их интратекальному происхождению и/или наличию патологического процесса в интратекальном пространстве. Зачастую высокие концентрации белка в ликворе обусловлены его повышенным притоком из крови. Определить источник белка — интратекальный или гематогенный — можно при помощи ликвор-сывороточных индексов, рассчитанных по методу, разработанному немецким ликворологом Hansotto Reiber. Этот метод признан актуальным для разграничения гематогенных и интратекальных фракций белков немецким обществом ликвородиагностики и нейрохимии (Deutsche Gesellschaft für Liquordiagnostik und Klinische Neurochemie e.V.). В настоящем обзоре, подготовленном на основании анализа научной литературы, представленной в основных базах данных (PubMed, CyberLeninka, Google Scholar, Scopus) с использованием последних зарубежных изданий по ликвородиагностике, описана методика расчета ликвор-сывороточных индексов для общих классов иммуноглобулинов, антительных индексов для специфических антител, рассмотрена структура райберограмм (диаграмм зависимости альбуминового индекса Q<sub>alb</sub> от ликвор-сывороточного индекса общих иммуноглобулинов). В статье приведена классификация интратекального воспаления, описаны характерные паттерны интратекального синтеза иммуноглобулинов для различных заболеваний центральной и периферической нервной системы. Таким образом, настоящий обзор литературы позволяет детально погрузиться в общие принципы современного подхода к оценке белкового состава спинномозговой жидкости и улучшить понимание интратекального гуморального ответа. Дополнительно в статье резюмированы данные последних исследований, посвященных особенностям интратекального иммунного ответа при рассеянном склерозе, заболеваниях спектра нейрооптикомиелита и энцефалитах, ассоциированных с анти-MOG, анти-NMDAR антителами, ревматологических заболеваниях с поражением ЦНС и нейроинфекциях.</p></trans-abstract><kwd-group xml:lang="en"><kwd>cerebrospinal fluid</kwd><kwd>liquor</kwd><kwd>blood serum</kwd><kwd>index</kwd><kwd>Reiber</kwd><kwd>intrathecal synthesis</kwd><kwd>albumin quotient</kwd><kwd>QAlb</kwd><kwd>antibody index</kwd><kwd>Reibergram</kwd><kwd>liquorology</kwd></kwd-group><kwd-group xml:lang="ru"><kwd>спинномозговая жидкость</kwd><kwd>ликвор</kwd><kwd>сыворотка крови</kwd><kwd>индекс</kwd><kwd>Райбер</kwd><kwd>интратекальный синтез</kwd><kwd>альбуминовый индекс</kwd><kwd>QAlb</kwd><kwd>антительный индекс</kwd><kwd>райберограмма</kwd><kwd>ликворология</kwd></kwd-group><funding-group/></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><mixed-citation>Зверева Н.Н., Шакарян А.К., Сайфуллин Р.Ф., Россина А.Л., Ртищев А.Ю., Белялетдинова И.Х. 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