脑脊液白细胞、24 h鞘内IgG合成率等指标在鞘内IgG合成阳性患者中的变化研究

Changes in cerebrospinal fluid leukocytes and 24-hour intrathecal IgG synthesis rate in the patients with positive intrathecal IgG synthesis

目的对神经系统疾病患者的脑脊液和血浆指标与鞘内免疫球蛋白G(IgG)合成关系进行实验室评估,建立诊断鞘内IgG合成的新方法。方法本研究回顾性分析了2019—2022年北京天坛医院就诊的410例神经系统疾病患者的脑脊液和血白蛋白、IgG等检测结果。根据脑脊液寡克隆区带结果,将患者分为鞘内IgG合成组和无鞘内IgG合成组。组间比较采用Mann-Whitney U检验,双侧检验P<0.05为差异有统计学意义。将组间存在差异的指标纳入Logistic回归分析,构建预测模型,并与已建立的定量公式IgG指数进行比较。结果在鞘内IgG合成组和无鞘内IgG合成组,脑脊液白细胞计数、24 h鞘内IgG合成率等10项指标差异有统计学意义(P<0.05)。联合存在差异的10项指标诊断鞘内IgG合成的曲线下面积(AUC)高于IgG指数(AUC分别为0.920和0.809,Z=31.178,P<0.001),敏感度高于IgG指数(分别为0.825、0.618),特异度低于IgG指数(分别为0.876、0.908)。结论脑脊液白细胞计数、24 h鞘内IgG合成率等10项指标联合能够提高鞘内IgG合成的诊断效能和敏感度。

Objective Laboratory evaluation of the relationship between cerebrospinal fluid and plasma indicators and intrathecal immunoglobulin G(IgG)synthesis in patients with neurological diseases,and establishment of a new diagnostic method for intrathecal IgG synthesis.Methods This study retrospectively analyzed the content of IgG in cerebrospinal fluid samples and blood albumin in blood samples,and other test results of 410 patients with neurological diseases who visited Beijing Tiantan Hospital from 2019 to 2022.According to the results of oligoclonal bands in cerebrospinal fluid,patients were divided into intrathecal IgG synthesis group and non-intrathecal IgG synthesis group.The Mann Whitney U test was used for inter group comparison,and a bilateral test with P<0.05 indicates a statistically significant difference.Include indicators with differences between groups in logistic regression analysis,construct a predictive model,and compare it with the established quantitative formula IgG index.Results There were significant differences in 10 indicators,including cerebrospinal fluid leukocyte count and 24-hour intrathecal IgG synthesis rate,between the intrathecal IgG synthesis group and the non-intrathecal IgG synthesis group,with P<0.05.The area under the curve(AUC)of intrathecal IgG synthesis was higher than the IgG index(AUC=0.920,0.809,Z=31.178,P<0.001),the sensitivity was higher than the IgG index(0.825,0.618),and the specificity was lower than the IgG index(0.876,0.908).Conclusion The combination of 10 indicators such as cerebrospinal fluid white blood cell count and 24-hour intrathecal IgG synthesis rate can improve the diagnostic efficacy and sensitivity of intrathecal IgG synthesis.