寡克隆区带阳性的神经型布鲁菌病患者的临床、影像学及脑脊液特点分析

Analysis of clinical,imaging and cerebrospinal fluid characteristics of neurobrucellosis patients with positive oligoclonal bands

目的探讨寡克隆区带(OCB)阳性的神经型布鲁菌病(NB)患者的临床、影像学及脑脊液特点。方法回顾性分析郑州大学第一附属医院2020年1月至2023年6月间确诊为NB的23例患者,男9例,女14例,年龄47(34,59)岁。根据血清及脑脊液IgG电泳结果将NB患者分为OCB阳性组和OCB阴性组,比较两组的临床、影像学及脑脊液特点。结果23例NB中脑脊液OCB阳性者占65.2%(15/23),以Ⅱ型(14/15)为主;阴性组8例。OCB阳性组临床重型占比(11/15)、脑脊液白细胞计数升高占比(15/15)、IgG指数[M(Q_(1),Q_(3)),0.97(0.57,2.11)],24 h鞘内合成率[55.6(15.3,232.2)mg/24 h]显著高于阴性组[1/8,5/8,0.63(0.51,0.69),11.6(-1.6,17.3)mg/24 h,均P<0.05]。两组患者在病程、临床分型上差异无统计学意义(均P>0.05)。OCB阳性组可表现为全脑(幕上合并幕下)脑实质多发病灶(5/15),但OCB阴性组均未发现幕下脑实质受累(0/8)。结论NB患者OCB阳性检出率为65.2%。OCB阳性者临床重症患者更多,神经系统鞘内体液免疫炎性反应更严重,较OCB阴性组更易出现幕下脑实质受累。

Objective To investigate the clinical,imaging and cerebrospinal fluid characteristics of neurobrucellosis(NB)patients with positive oligoclonal bands(OCB).Methods A total of 23 patients diagnosed with NB from the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2023 were retrospectively analyzed,including 9 males and 14 females,aged 47(34,59)years old.NB patients were divided into OCB positive group and OCB negative group according to the results of IgG electrophoresis in serum and cerebrospinal fluid.The clinical,imaging and cerebrospinal fluid characteristics of the two groups were compared.Results Cerebrospinal fluid OCB positive in 23 cases of NB accounted for 65.2%(15/23),mainly typeⅡ(14/15).There were 8 patients in the negative group.The proportion of clinical severe patients(11/15),the proportion of patients with elevated leukocyte in cerebrospinal fluid(15/15),IgG index[M(Q_(1),Q_(3)),0.97(0.57,2.11)],and 24 h intrathecal synthesis rate[55.6(15.3,232.2)mg/24 h]in OCB positive group were significantly higher than those in the negative group[1/8,5/8,0.63(0.51,0.69),11.6(-1.6,17.3)mg/24 h,both P<0.05].There was no significant difference in the course of disease and clinical type between the two groups(both P>0.05).The OCB-positive group showed multiple brain parenchymal lesions in the whole brain(supratentorial combined with supratentorial)(5/15),but no supratentorial parenchymal involvement was found in the OCB-negative group(0/8).Conclusions The OCB positive rate in NB patients is 65.2%.Compared with the OCB negative group,the OCB positive patients have more severe clinical symptoms,with more severe intrathecal humoral immune inflammatory reactions of the nervous system,and more likely to have subtentorial brain parenchyma involvement.