神经系统脱髓鞘疾病中脑脊液胱氨酸蛋白酶抑制剂C的临床价值

The Clinical Study of the Cystatin C Existing in Cerebrospinal Fluid in Neuronal Demyelinative Diseases

目的探讨脑脊液胱氨酸蛋白酶抑制剂C（Cystatin C）在以脱髓鞘病变为共有特征的神经系统疾病中的临床应用价值。方法收集神经系统脱髓鞘疾病患者76例及正常对照者27例,以增强透射免疫比浊法测定脑脊液Cystatin C水平,并同时测定脑脊液葡萄糖、脑脊液乳酸、脑脊液蛋白及脑脊液白蛋白水平,对比不同分组方式下神经系统脱髓鞘疾病与正常对照组间及不同类型神经系统脱髓鞘疾病组间脑脊液Cystatin C表达水平的差异;对脑脊液Cystatin C判断神经系统脱髓鞘疾病进行ROC曲线分析。结果神经系统脱髓鞘改变者脑脊液Cystatin C水平为（3.80±1.29）mg/L,较正常对照组（5.36±1.07）mg/L下降,均值比较差异具有统计学意义（P〈0.05）。中枢神经系统脱髓鞘疾病和周围神经系统脱髓鞘疾病脑脊液Cystatin C水平均较正常对照组降低（P均〈0.05）;观测组间比较P〉0.05。组间脑脊液Cystatin C单因素ANOVA结果表明各病理分组中该标志物均值比较差异无统计学意义（P〉0.05）。ROC曲线图表明,AUC=83.0%,95%CI AUC=75.2%-90.9%,最佳诊断阈值为4.37mg/L;该水平时敏感度为72.4%,特异度为88.9%。结论脑脊液Cystatin C在神经系统脱髓鞘疾病中均表现出不同程度低水平表达,ROC曲线分析表明脑脊液Cystatin C水平低于4.37mg/L对脱髓鞘性神经系统疾病具有较好的判断效能,该标志物在以脱髓鞘病变为特征的神经系统疾病的诊治过程中有一定临床实用价值,但尚需结合其他临床诊治资料进行深入分析。

Objective To explore the clinical value of the Cystatin C existing in cerebrospinal fluid in the demyelinative disease of the nervous system.Methods The levels of cerebrospinal fluid Cystatin C of 76 patients with the demyelinate disease of the nervous system and 27 patients without disease of the nervous system had been embraced in the study.The Cystatin C clevel was measured by the immunity transmission turbidimetry,and meanwhile the levels of glucose,lactic acid,total protein,microalbumin in cerebrospinal fluid were also detected in the observation so as to compare with the Cystatin C＇s expression levels in different groups and analyze the situation of the Cystatin C diagnosing the demyelinative disease according to the ROC curve of the Cystatin C.Results The average level of cerebrospinal fluid Cystatin C of the patients with demyelinate disease of the nervous system（3.80±1.29）mg/L had decreased comparing with the normal control groups（5.36±1.07）mg/L,（P〈0.05）;The average levels of Cystatin C of central and peripheral nervous system demyelinate diseases had also decreased comparing with the normal control groups（P〈0.05）;the Cystatin C in Cerebrospinal fluid of each pathological groups were no statistically significant;ROC curve showed that if cerebrospinal fluid Cystatin C＇s level was lower than 4.37mg/L,it was easy to distinguish demyelinate disease from normal controls,the sensitivity was 72.4% and the specificity was88.9%.Conclusion The low levels of the Cystatin C in demyelinate disease of nervous system express differently and the results of ROC curve indicat it is effective,to diagnose and treat demyelinate diseases when the level of the Cystatin C is below 4.37mg/L,that is,the practical maker is quite clinical valuable in this kind of nervous system therapy,even though now it is worth nothing to differentiate the Cystatin C with other clinical markers in the treatment of demyelinate diseases.