周围血B细胞上升幅度与自身免疫性脑炎复发的相关性研究

The correlation between the increase of peripheral blood B cells and the recurrence of autoimmune encephalitis

目的分析周围血淋巴细胞亚群特别是B细胞与自身免疫性脑炎(AE)复发的相关性。方法收集北京协和医院2012年1月至2023年1月诊治的AE患者的临床资料,包括患者的性别、年龄和疾病复发前后CD19^(+)B细胞、CD16/56^(+)NK细胞、CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞、IgG、IgA及IgM相关指标的变化。采用二元Logistic回归法对AE是否复发与患者的性别、年龄和CD19^(+)B细胞、CD16/56^(+)NK细胞、CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞、IgG、IgA、IgM水平进行相关性分析,并对影响AE复发的CD19^(+)B细胞、CD16/56^(+)NK细胞、CD3^(+)T细胞、CD4^(+)T细胞及CD8^(+)T细胞进行受试者工作特征(ROC)曲线分析。结果共纳入198例符合条件的AE患者,其中男性98例、女性100例,年龄(39.52±17.91)岁。复发型占78例,复发比例为39.4%。Logistic回归分析结果显示,患者的CD19^(+)B细胞(B=0.006,P<0.001)、CD16/56^(+)NK细胞(B=0.004,P<0.05)、CD3^(+)T细胞(B=-0.011,P<0.05)、CD4^(+)T细胞(B=0.014,P<0.05)及CD8^(+)T细胞(B=0.010,P<0.05)与AE复发具有高度相关性。ROC曲线分析结果显示,CD19^(+)B细胞(曲线下面积=0.833,P<0.001,临界值73.5个/μl,敏感度69.2%,特异度86.7%)、CD3^(+)T细胞(曲线下面积=0.784,P<0.001)、CD4^(+)T细胞(曲线下面积=0.808,P<0.001)及CD8^(+)T细胞(曲线下面积=0.742,P<0.001)亦对AE复发有一定的预测性。其中以CD19^(+)B细胞曲线下面积最大,预测AE复发的价值较高。结论外周血CD19^(+)B细胞的升高幅度对AE的复发具有较高的预测价值。

Objective To analyze the correlation between peripheral blood lymphocyte subsets,especially B cells,and the relapse of autoimmune encephalitis(AE).Methods A retrospective analysis was conducted on patients with AE who were diagnosed and treated in Peking Union Medical College Hospital from January 2012 to January 2023.The clinical data including gender,age and changes in related indicators of CD19^(+)B cells,CD16/56^(+)NK cells,CD3^(+)T cells,CD4^(+)T cells,CD8^(+)T cells,IgG,IgA,and IgM before and after recurrence were analyzed.Binary Logistic regression analysis was applied to the study of correlation between AE recurrence and gender,age,CD19^(+)B cells,CD16/56^(+)NK cells,CD3^(+)T cells,CD4^(+)T cells,CD8^(+)T cells,IgG,IgA and IgM.The receiver operating characteristic(ROC)curves of the cells that affect AE recurrence(CD19^(+)B cells,CD16/56^(+)NK cells,CD3^(+)T cells,CD4^(+)T cells and CD8^(+)T cells)were plotted separately.Results A total of 198 eligible AE patients were included,including 98 males and 100 females,aged(39.52±17.91)years.Among these patients,78 cases had relapses,with a recurrence rate of 39.4%.The results of Logistic regression analysis showed that CD19^(+)B cells(B=0.006,P<0.001),CD16/56^(+)NK cells(B=0.004,P<0.05),CD3^(+)T cells(B=-0.011,P<0.05),CD4^(+)T cells(B=0.014,P<0.05)and CD8^(+)T cells(B=0.010,P<0.05)were highly correlated with the relapse of AE.ROC curve analysis showed that CD19^(+)B cells(area under the curve:0.833,P<0.001,critical value:73.5/μl;sensitivity:69.2%,specificity:86.7%),CD3^(+)T cells(area under the curve:0.784,P<0.001),CD4^(+)T cells(area under the curve:0.808,P<0.001),and CD8^(+)T cells(area under the curve:0.742,P<0.001)all had a certain predictive value for AE relapse.Among all the indicators,the area under the curve of CD19^(+)B cells was the largest,which had a higher value in predicting AE recurrence.Conclusion The increase in peripheral blood CD19^(+)B cells has high predictive value for the relapse of AE.