脑脊液下丘脑分泌素水平测定对中国发作性睡病患者的诊断价值

Value of cerebral spinal fluid measurement of hypocretin-1 in the diagnosis of Chinese patients with narcolepsy

目的评价脑脊液下丘脑分泌素-1（hcrt-1）水平测定对中国发作性睡病患者的诊断价值。方法2003年4月至2012年3月于北京大学人民医院就诊的发作性睡病患者139例（发作性睡病组），其中伴典型猝倒者（NC亚组）111例，不伴典型猝倒者（NWC亚组）28例。对照组为64例因下肢手术而进行硬膜外麻醉者，均无白天嗜睡而排除发作性睡病。两组均进行脑脊液hcrt-1测定。通过受试者工作特征（ROC）曲线确定适合中国人群的hcrt-1诊断界值，并以国际通用的hcrt-1≤110．0ng／L和hcrt-1≤30％正常平均值（即hcrt-1≤96．2ng／L）为标准，作为诊断标准分析hcrt·1测定对发作性睡病的诊断价值。结果发作性睡病组的hcrt-1水平为20（13，36）ng／L，明显低于对照组的319（244，379）ng／L和NWC亚组的36（15，114）ng／L（均P〈0．01）；以hcrt-1≤110．0ng／L作为标准对发作性睡病诊断的敏感度为90．6％，特异度为100％。以hcrt-1≤30％正常平均值作为诊断标准，所得敏感度、特异度与以hcrt．1≤110．0ng／L为标准完全相同。通过ROC曲线得出适合中国人群的hcrt-1诊断界值为hcrt．1≤138．0ng／L，以该标准诊断对发作性睡病的特异度及敏感度分别为100％及92．8％，ROC曲线下面积达到0．98。结论脑脊液hcrt检测对中国发作性睡病患者具有很高的敏感度与特异度，以脑脊液hcrt-1≤138ns／L为标准更适合于对中国人群发作性睡病的诊断。

Objective To evaluate the diagnostic value of cerebral spinal fluid （CSF）measurement of hypocretin-1 （ hcrt-1 ） in Chinese patients with narcolepsy. Methods A total of 139 narcoleptic patients, including 111 narcolepsy with typical eataplexy （ NC ） and 28 narcolepsy without cataplexy （ NWC ）, were diagnosed at the sleep centre of Peking University People＇s Hospital from April 2003 to March 2012. And 64 non-narcoleptic controls were recruited. CSF hcrt-1 levels were measured in all subjects. Receiver operating characteristic curve （ ROC ） was applied to determine the cutoff value of herr-1 for Chinese narcolepstic patients. The diagnostic utility of hcrt-1 ≤ 110.0 ng,/L and hcrt-1 ≤ 30% of mean normal level defined by International Classification of Sleep Disorders-II and the new Chinese cutoff value were evaluated respectively. Results The level of hcrt-1 in narcolepsy patients was significantly lower than that of normal controls and the NC group was even lower than NWC group （20 （13, 36） vs 319 （244,379） and 36 （15, 114） ng/L） （ all P 〈 0. O1 ）. Using the international criteria of CSF hcrt-1 ≤ 110. 0 ng/L or a level of 1/3 of mean normal control values, a specificity of 100% and sensitivity of 90. 6% were generated. ROC curve indicated that CSF herr-1 level of 138.0 ng/L was the best cutoff value for the diagnosis of narcolepsy in Chinese narcoleptic patients. There were a specificity of 100% , a sensitivity of 92. 8% and the area under the ROC curve of 0. 98. Conduslons CSF herr-1 measurement with high specificity and sensitivity is a useful diagnostic tool for Chinese narcoleptics. And the level of 138.0 ng/L may be the optimal cutoff for the diagnosis of narcolepsy in this group of patients.