B细胞活化因子与小儿自身免疫性脑炎严重程度的相关性分析

Correlation between B-cell activating factor and severity of children′s autoimmune encephalitis

目的分析B细胞活化因子(BAFF)与小儿自身免疫性脑炎严重程度的相关性,为临床诊治小儿自身免疫性脑炎提供思路。方法该研究采用病例-对照的研究方法,将该院2020年1月至2022年6月收治的45例自身免疫性脑炎患儿作为病例组,另将该院同期收治的45例病毒性脑炎患儿作为对照组;查阅两组患儿电子病历档案,收集性别、年龄、临床特征、脑脊液BAFF、血清BAFF等临床资料;应用改良Rankin量表(mRS)评估自身免疫性脑炎患儿的病情严重程度,比较轻度组、中重度组患儿实验室资料及影像学资料,分析BAFF与小儿自身免疫性脑炎严重程度的关系。结果病例组临床特征为精神行为异常、认知障碍、癫痫发作、语言障碍、意识障碍占比高于对照组,临床特征为发热、恶心占比低于对照组,差异有统计学意义(P<0.05);病例组脑脊液BAFF及血清BAFF水平低于对照组,差异有统计学意义(P<0.05);病例组与对照组其他资料对比,差异无统计学意义(P>0.05);45例自身免疫性脑炎患儿经评估,病情程度为轻度28例,中重度17例;轻度组白细胞计数、中性粒细胞计数、mRS评分低于中重度组,白蛋白、脑脊液BAFF及血清BAFF水平高于中重度组,差异有统计学意义(P<0.05);其他不同病情程度患儿实验室资料及影像学资料对比,差异无统计学意义(P>0.05);经Point-biserial相关性分析显示,脑脊液BAFF及血清BAFF与小儿自身免疫性脑炎严重程度均呈负相关(r=-0.524、-0.562,P<0.05);经Pearson相关性分析显示,自身免疫性脑炎患儿脑脊液BAFF与血清BAFF呈正相关(r=0.437,P<0.05);绘制受试者工作特征曲线,结果显示,脑脊液BAFF、血清BAFF预测小儿自身免疫性脑炎严重程度的曲线下面积均>0.7,均具有良好的预测价值。结论BAFF与小儿自身免疫性脑炎严重程度密切相关,且对预测小儿自身免疫性脑炎严重程度具有良好的价值。

Objective To analyze the correlation between B-cell activating factor(BAFF)and the severity of children′s autoimmune encephalitis,and to provide ideas for clinical diagnosis and treatment of children′s autoimmune encephalitis.Methods A case-control research method was used in this study.A total of 45 children with autoimmune encephalitis admitted to the hospital from January 2020 to June 2022 were taken as the case group,and 45 children with viral encephalitis admitted to the hospital at the same time were taken as the control group.The electronic medical records of the two groups of children were consulted and the data of gender,age,clinical characteristics,cerebrospinal fluid BAFF,serum BAFF,etc.were obtained.The modified Rankin Scale(mRS)was used to evaluate the severity of children with autoimmune encephalitis.The laboratory data and imaging data of children in mild and moderate severe groups were compared,and the relationship between BAFF and the severity of children′s autoimmune encephalitis was analyzed.Results The propotion of patients with clinical features,including abnormal mental behavior,cognitive disorder,epileptic seizure,speech disorder and consciousness disorder in the case group were higher than that in the control group,and the propotion of patients with clinical features,including fever and nausea were lower than that in the control group,and the differences were statistically significant(P<0.05).The levels of cerebrospinal fluid BAFF and serum BAFF in the case group were lower than those in the control group,and the differences were statistically significant(P<0.05).There were no statistical significant differences in other data between the case group and the control group(P>0.05).Among 45 children with autoimmune encephalitis,there were 28 cases with mild symptoms and 17 cases with moderate to severe symptoms.The white blood cell count,neutrophil count and mRS score in the mild group were lower than those in the moderate and severe group,while the levels of albumin,cerebrospinal fluid BAFF and serum BAFF in mild group were higher than those in moderate and severe group,and the differences were statistically significant(P<0.05).There were no statistical significant differences in laboratory data and imaging data of other children with different disease severity(P>0.05).Point-biserial correlation analysis showed that cerebrospinal fluid BAFF and serum BAFF were negatively correlated with the severity of children′s autoimmune encephalitis(r=-0.524,-0.562,P<0.05).Pearson correlation analysis showed that there was a positive correlation between cerebrospinal fluid BAFF and serum BAFF in children with autoimmune encephalitis(r=0.437,P<0.05).The receiver operating characteristic curve was drawn,and the results showed that the area under the curve of cerebrospinal fluid BAFF and serum BAFF for predicting the severity of children′s autoimmune encephalitis was greater than 0.7,which had good predictive value.Conclusion BAFF is closely related to the severity of children′s autoimmune encephalitis,and has good value in predicting the severity of children′s autoimmune encephalitis.