抗N-甲基-D-天冬氨酸受体脑炎患者脑脊液细胞学特点分析

Characteristics of cerebrospinal fluid cytology in patients with anti-N-methyl-D-aspartate receptor encephalitis

目的探讨抗N-甲基-D-天冬氨酸受体(anti-N-methyl-D-aspartate receptor,NMDAR)脑炎的脑脊液细胞学特点。方法收集2015-01-01—2018-12-31河南省人民医院及北京协和医院收治的抗NMDAR脑炎患者的脑脊液细胞学、常规、生化、抗NMDAR抗体滴度、寡克隆区带等结果,并分析其特点。结果共收集164例患者。112例患者脑脊液细胞学可见炎性反应,炎性反应为轻、中、重度者分别为46、58、8例。89例为淋巴细胞性炎性反应,22例为淋巴细胞与中性粒细胞性炎性反应,1例为淋巴细胞、中性粒细胞与嗜酸性粒细胞性炎性反应。51例可见激活淋巴细胞,16例可见浆细胞。45.9%(51/111)的患者可见脑脊液特异性寡克隆区带。脑脊液常规正常患者改量Rankin量表评分(mRS)与脑脊液细胞学白细胞计数、炎性反应程度呈正相关(r=0.259,P=0.047;r=0.264,P=0.043),且脑脊液细胞学炎性反应组神经功能残障程度(mRS>3)较脑脊液细胞学阴性组更重(χ^(2)=5.544,P=0.019)。结论脑脊液细胞学具有发现脑脊液常规阴性患者炎性反应的检测能力及评价抗NMDAR脑炎患者神经功能严重程度的价值,可作为评估抗NMDAR脑炎的重要方法。

Objective To explore the characteristics of cerebrospinal fluid(CSF)cytology in anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis.Methods The CSF data was collected from patients with anti-NMDAR encephalitis admitted into Henan Provincial People s Hospital and Peking Union Medical College Hospital from 01 January 2015 to 31 December 2018.Cytological characteristics and other parameters of the CSF were analyzed.Results CSF cytological data were obtained from 164 patients with anti-NMDAR encephalitis.Signs of inflammation were identified in cytological analyses of 112 patients’CSF,including 46 cases with mild inflammation,58 with moderate inflammation,and 8 with severe inflammation.With regard to inflammation type,89 cases were classified as lymphocytic inflammation,22 as mixed inflammation with both lymphocytes and neutrophils,and 1 case was classified as mixed inflammation with lymphocytes,neutrophils,and eosinophils.Activated lymphocytes were detected in 51 patients,and plasma cells were detected in 16.Oligoclonal bands were tested in 111 patients,and 51(45.9%)patients had positive specific oligoclonal bands in CSF.In the non-pleocytosis subgroup based on routine CSF examination,the modified Rankin scale(mRS)score was positively correlated with white cell count and degree of inflammation determined via CSF cytology(r=0.259,P=0.047;r=0.264,P=0.043,respectively),and patients with CSF inflammation detected by cytology were more likely to have more serious disease severity(mRS>3)(χ^(2)=5.544,P=0.019)in comparison to patients with negative cytological findings.Conclusions The ability of detecting inflammatory state that does not exhibit in routine CSF examination and the value of assessing the neurological severity in patients with anti-NMDAR encephalitis render CSF cytology to be an important tool for evaluating anti-NMDAR encephalitis.