脑脊液免疫球蛋白、外周血炎症细胞指标及细胞免疫指标在儿童自身免疫性脑炎中的临床诊断价值

Clinical diagnostic value of immunoglobulins in cerebrospinal fluid,inflammatory cells in peripheral blood and cellular immune indexes in children with autoimmune encephalitis

目的探讨脑脊液免疫球蛋白、外周血炎症细胞指标及细胞免疫指标在儿童自身免疫性脑炎(AE)中的临床诊断价值。方法选取2022年1月至2023年12月江西省儿童医院收治的36例AE患儿纳入AE组,另选取江西省儿童医院同期收治的36例病毒性脑炎(VE)儿童作为VE组。比较两组的脑脊液IgM、IgG、IgA水平和外周血中性粒细胞计数/淋巴细胞计数比值(NLR)、单核细胞计数/淋巴细胞计数比值(MLR)、血小板计数/淋巴细胞计数(PLR)、CD3^(+)、CD4^(+)/CD8^(+)、自然杀伤(NK)细胞比例;采用受试者工作特征(ROC)曲线分析脑脊液免疫球蛋白、外周血炎症细胞指标及细胞免疫指标对AE的诊断价值。结果AE组的脑脊液IgM、IgG和IgA水平高于VE组,差异有统计学意义(P<0.05);AE组的NLR、MLR和PLR高于VE组,差异有统计学意义(P<0.05);AE组的CD3^(+)、CD4^(+)/CD8^(+)和NK细胞比例水平低于VE组,差异有统计学意义(P<0.05);ROC曲线分析结果显示,IgM、IgG、IgA、NLR、MLR、PLR、CD3^(+)、CD4^(+)/CD8^(+)、NK细胞比例诊断AE的曲线下面积(AUC)分别为0.844、0.874、0.885、0.741、0.767、0.668、0.793、0.796和0.671(P<0.05)。结论脑脊液免疫球蛋白、外周血炎症细胞指标及细胞免疫指标对AE均具有一定的诊断价值,其中脑脊液免疫球蛋白水平诊断效能最高。

Objective To explore the clinical diagnostic value of immunoglobulins in cerebrospinal fluid,inflammatory cells in peripheral blood and cellular immune indexes in children with autoimmune encephalitis(AE).Methods A total of 36 children with AE admitted to Jiangxi Provincial Children's Hospital from January 2022 to December 2023 were selected as the AE group,and 36 children with viral encephalitis(VE)admitted to Jiangxi Provincial Children's Hospital during the same period were selected as the VE group.The levels of IgM,IgG and IgA in cerebrospinal fluid,neutrophil count/lymphocyte count ratio(NLR),monocyte count/lymphocyte count ratio(MLR)and platelet count/lymphocyte count ratio(PLR)in peripheral blood,and proportions of CD3^(+),CD4^(+)/CD8^(+)and natural killer(NK)cells were compared between the two groups.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of cerebrospinal fluid immunoglobulin,peripheral blood inflammatory cell markers and cellular immune markers for AE.Results The levels of IgM,IgG and IgA in cerebrospinal fluid in AE group were higher than those in VE group,and the differences were statistically significant(P<0.05).The levels of NLR,MLR and PLR in AE group were significantly higher than those in VE group,and the differences were statistically significant(P<0.05).The proportions of CD3^(+),CD4^(+)/CD8^(+)and NK cells in AE group were lower than those in VE group,and the differences were statistically significant(P<0.05).The ROC curve analysis showed that area under the curve(AUC)values of IgM,IgG,IgA,NLR,MLR,PLR,CD3^(+),CD4^(+)/CD8^(+)and NK cells in the diagnosis of AE were 0.844,0.874,0.885,0.741,0.767,0.668,0.793,0.796 and 0.671,respectively(P<0.05).Conclusion Immunoglobulins in cerebrospinal fluid,inflammatory cells in peripheral blood and cellular immune indexes all have certain diagnostic value for AE.Among them,the level of cerebrospinal fluid immunoglobulin has the highest diagnostic efficiency.