吉兰-巴雷综合征与视神经脊髓炎谱系疾病患者脑脊液检测比较分析

A Comparative Study of Cerebrospinal Fluid Laboratory Test Results Between Guillain-BarréSyndrome and Neuromyelitis Optica Spectrum Disorder

目的比较吉兰-巴雷综合征(GBS)和视神经脊髓炎谱系疾病(NMOSD)患者脑脊液实验室检测结果特征,为两种疾病的诊断和鉴别提供依据。方法选择2020年5月至2024年4月于北京天坛医院确诊的66例NMOSD和74例GBS患者为研究对象。分析两组患者一般临床资料,比较两组脑脊液常规、脑脊液生化、脑脊液细胞因子(TNF-α、IL-6、IL-8)、脑脊液寡克隆区带电泳、脑脊液神经系统感染病原体抗体(单纯疱疹病毒抗体、巨细胞病毒抗体、风疹病毒抗体、弓形虫抗体、EB病毒抗体、柯萨奇病毒抗体)以及脑脊液IgG指数、白蛋白商(QAlb)之间差异。结果两组间性别构成之间差异显著,NMOSD患者以女性为主,GBS患者以男性为主(P<0.001)。GBS患者脑脊液白细胞数显著低于NMOSD组,蛋白水平显著高于NMOSD组(P=0.041,P<0.001)。GBS患者脑脊液TNF-α、IL-6和IL-8水平显著高于NMOSD组(P=0.001,P=0.009,P<0.001)。GBS患者脑脊液CMV IgG、TOX IgG、EBVCA-IgG阳性率分别为84.48%(49/58)、32.76%(19/58)、18.97%(11/58)显著高于NMOSD组61.67%(37/60)、1.67%(1/60)、5.00%(3/60),(P=0.015,P<0.001,P=0.019)。GBS患者OCB阳性率2.99%(2/67)显著低于NMOSD组16.39%(10/61)(P=0.009),QAlb异常率80.60%(54/67)显著高于NMOSD组45.90%(28/61)(P<0.001)。结论NMOSD患者脑脊液OCB阳性率高于GBS患者,GBS患者表现为脑脊液蛋白-细胞分离现象,且血脑屏障损伤率较高,脑脊液神经系统感染病原体抗体阳性率及炎性因子水平较NMOSD高。

Objective To compare characteristics of cerebrospinal fluid(CSF)laboratory test results between patients with neuromyelitis optica spectrum disorder(NMOSD)and Guillain-Barrésyndrome(GBS),and to further provide reference basis for the diagnosis and antidiastole of these two types of diseases.Methods 66 patients diagnosed with NMOSD and 74 patients diagnosed with GBS in Beijing Tiantan Hospital from May,2020 to April,2024 were selected as the research subjects.We evaluated the general clinical conditions of these two groups of patients.The CSF routine,CSF biochemistry,CSF cytokines(TNF-α,IL-6,IL-8),antibodies to herpes simplex virus,cytomegalovirus,rubella virus,toxoplasma gondii,Epstein-Barr virus,coxsackievirus,oligoclonal band electrophoresis,immunoglobulin G(IgG)index,and QAlb were performed on the clinical specimens and results were compared between the two groups.Results There was a significant difference in sex ratio between the two groups.The majority of patients in NMOSD group were female,while the majority of patients in GBS group were male(P<0.001).The number of white blood cells in CSF of GBS patients was significantly lower than that of NMOSD patients,while the protein levels was significantly higher than that of NMOSD group(P=0.041,P<0.001).The levels of TNF-α,IL-6 and IL-8 in CSF of GBS patients were significantly higher than those of NMOSD patients(P=0.001,P=0.009,P<0.001).The positive rates of CMV IgG,TOX IgG,and EBVCA IgG in CSF of GBS patients[84.48%(49/58)、32.80%(19/58)、19.00%(11/58)]were higher than those of NMOSD patients[61.67%(37/60)、1.67%(1/60)、5.00%(3/60)].Compared with NMOSD patients,the positive rate of oligoclonal band(OCB)electrophoresis in GBS patients was significantly decreased(P=0.013),while the abnormal rate of QAlb in GBS patients was significantly increased(P<0.001).Conclusion NMOSD patients have a higher positive rate of OCB electrophoresis than that of GBS patients.GBS patients have albuminocytologic dissociation in CSF.Furthermore,GBS patients have elevated levels of inflammatory factor,higher positive rates of both blood-brain barrier injury and antibodies to pathogens of nervous system infection in CSF.