摘要
目的比较多发性硬化(MS)和吉兰-巴雷综合征(GBS)脑脊液检测结果的特点,为2种神经系统脱髓鞘疾病的鉴别诊断提供依据。方法病例分析。以2020年1月至2023年8月在首都医科大学附属北京天坛医院就诊的患者为研究对象,其中MS患者70例[男性19例,女性51例,年龄34(28,44)岁],GBS患者70例[男性44例,女性26例,年龄50(36,61)岁]。对2组患者进行寡克隆区带电泳及免疫球蛋白G指数(IgG I)检测,同时检测脑脊液常规、脑脊液生化(葡萄糖、氯、蛋白)、乳酸、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、单纯疱疹病毒(HSV)抗体、巨细胞病毒(CMV)抗体、风疹病毒(RV)抗体、弓形虫(TOX)抗体、EB病毒(EBV)抗体、柯萨奇病毒(COX)抗体。计数资料比较采用χ^(2)检验;计量资料不符合正态分布,比较采用Mann-Whitney U检验。结果MS患者和GBS患者寡克隆区带电泳的阳性率分别为80.00%(56/70)和4.29%(3/70),MS患者阳性率高于GBS患者(χ^(2)=82.289,P<0.001)。MS患者脑脊液白细胞数[5.50(3.00,11.00)个/μl]、氯[127(125,128)mmol/L]水平均高于GBS患者[3.50(2.00,7.00)个/μl,126(124,128)mmol/L](U=-2.245,P<0.05;U=-2.028,P<0.05),脑脊液蛋白[33.40(27.61,39.17)mg/L]、葡萄糖[3.59(3.36,3.88)mmol/L]和乳酸[1.55(1.40,1.73)mmol/L]水平低于GBS患者[76.71(43.78,138.30)mg/L,3.97(3.55,4.54)mmol/L,1.80(1.60,2.00)mmol/L](U=-6.747,P<0.001;U=-3.651,P<0.001;U=-4.531,P<0.001)。MS患者脑脊液中IL-6[3.36(2.34,5.02)pg/ml]、IL-8[55.40(46.75,66.40)pg/ml]和TNF-α[5.63(4.25,6.63)pg/ml]水平均低于GBS患者[6.12(3.61,11.73)pg/ml,120.00(74.90,187.80)pg/ml,6.57(5.25,8.03)pg/ml](U=-3.463,P<0.05;U=-5.225,P<0.001;U=-2.785,P<0.05)。MS患者脑脊液中CMV IgG、TOX IgG、EBVCA-IgG阳性率分别为36.36%(24/66)、0、0,GBS患者脑脊液中CMV IgG、TOX IgG、EBVCA-IgG阳性率分别为85.71%(54/63)、30.16%(19/63)、19.05%(12/63),MS患者脑脊液中CMV IgG、TOX IgG、EBVCA-IgG阳性率低于GBS患者(χ^(2)=32.839,P<0.001;χ^(2)=23.343,P<0.001;χ^(2)=13.861,P<0.001)。结论MS患者主要表现为脑脊液寡克隆区带电泳阳性率较高。GBS患者脑脊液蛋白水平升高而白细胞数升高不明显,表现为脑脊液蛋白-细胞分离现象,同时鞘内免疫、炎症相关指标水平升高,病原体抗体阳性率较高。
Objective To compare the characteristics of cerebrospinal fluid(CSF)oligoclonal band electrophoresis examination results between patients with multiple sclerosis(MS)and Guillain-Barrésyndrome(GBS),and to provide a basis for the differential diagnosis of the two types of neurological demyelinating diseases.Methods Case analysis.The retrospective study method was used,and the patients who visited Beijing Tiantan Hospital,Capital Medical University from January 2020 to August 2023 were selected as the research subjects,including 70 MS patients[19 males and 51 females,aged 34(28,44)years]and 70 GBS patients[44 males and 26 females,aged 50(36,61)years].The oligoclonal band electrophoresis and immunoglobulin G(IgG)index(IgG I)were performed on the clinical specimens from MS and GBS patients,and CSF routine,CSF biochemistry(glucose,chloride,protein),lactate,interleukin-6(IL-6),interleukin-8(IL-8),and tumor necrosis factor-α(TNF-α),antibodies to herpes simplex virus(HSV),cytomegalovirus(CMV),rubella virus(RV),toxoplasma gondii(TOX),Epstein-Barr virus(EBV),and coxsackievirus were detected simultaneously.The enumeration data were treated with the chi-square test.The measurement data didn′t accord with normal distribution,and were treated with the Mann-Whitney U test.Results The positive rate of oligoclonal band(OCB)electrophoresis in MS and GBS patients were 80.00%(56/70)and 4.29%(3/70),respectively.The positive rate in MS patients was significantly higher than that in GBS patients(χ^(2)=82.289,P<0.001).The white blood cells count[5.50(3.00,11.00)/μl]and the level of chlorine[127(125,128)mmol/L]in CSF of MS patients was higher than that of GBS patients[3.50(2.00,7.00)/μl,126(124,128)mmol/L](U=-2.245,P<0.05;U=-2.028,P<0.05),while the levels of CSF protein[33.40(27.61,39.17)mg/L],glucose[3.59(3.36,3.88)mmol/L],and lactate[1.55(1.40,1.73)mmol/L]of MS patients were lower than those of GBS patients[6.71(43.78,138.30)mg/L,3.97(3.55,4.54)mmol/L,1.80(1.60,2.00)mmol/L](U=-6.747,P<0.001;U=-3.651,P<0.001;U=-4.531,P<0.001).The levels of IL-6[3.36(2.34,5.02)pg/ml],IL-8[55.40(46.75,66.40)pg/ml],and TNF-α[5.63(4.25,6.63)pg/ml]in CSF of MS patients were lower than those of GBS patients[6.12(3.61,11.73)pg/ml,120.00(74.90,187.80)pg/ml,6.57(5.25,8.03)pg/ml](U=-3.463,P<0.05;U=-5.225,P<0.001;U=-2.785,P<0.05).The positive rates of CMV IgG,TOX IgG,and EBVCA IgG in CSF of MS patients were 36.36%(24/66),0 and 0,respectively,and the positive rates of those of GBS patients were 85.71%(54/63),30.16%(19/63),and 19.05%(12/63),respectively.The positive rates of CMV IgG,TOX IgG,and EBVCA IgG in CSF of MS patients were significantly lower than those of GBS patients(χ^(2)=32.839,P<0.001;χ^(2)=23.343,P<0.001;χ^(2)=13.861,P<0.001).Conclusions The MS patients mainly showed the higher positive rates of OCB.The GBS patients showed elevated CSF protein levels but no significant increase in white blood cell count,namely albuminocytologic dissociation in CSF.Meanwhile,the GBS patients showed elevated levels of intrathecal immunity and inflammation indicators,and a higher positive rate of pathogen antibodies.
作者
马瑞敏
饶昕怡
陈宇欣
吕虹
张国军
Ma Ruimin;Rao Xinyi;Chen Yuxin;Lyu Hong;Zhang Guojun(Laboratory Department,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;The Fifth Clinical Medical College of Capital Medical University,Beijing 100070,China;Department of Clinical Laboratory Diagnosis,Capital Medical University,Beijing 100070,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2024年第2期136-141,共6页
Chinese Journal of Laboratory Medicine
基金
北京市医院管理中心登峰计划(DFL20220505)
北京市医院管理中心扬帆计划(ZYLX202108)
北京市高层次公共卫生技术人才建设项目培养计划(学科带头人-01-13)。
关键词
多发性硬化
吉兰-巴雷综合征
脱髓鞘疾病
脑脊髓液
Multiple sclerosis
Guillain-Barré syndrome
Demyelinating diseases
Cerebrospinal fluid
