[1]惠 博,陈 锟,王韬涛,等.重症脑炎患者脑脊液中寡克隆区带阳性率和IgG表达水平对预后预测的价值研究[J].现代检验医学杂志,2025,40(03):164-168.[doi:10.3969/j.issn.1671-7414.2025.03.030]
　HUI Bo,CHEN Kun,WANG Taotao,et al.Prognostic Value of Positive Rate of Olignoclonal Bands and IgG Expression Level in Corebrospinal fluid of Patients with Severe Encephalitis[J].Journal of Modern Laboratory Medicine,2025,40(03):164-168.[doi:10.3969/j.issn.1671-7414.2025.03.030]
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重症脑炎患者脑脊液中寡克隆区带阳性率和IgG表达水平对预后预测的价值研究()

《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年03期
页码:
164-168
栏目:
论著
出版日期:
2025-05-15

文章信息/Info

Title:
Prognostic Value of Positive Rate of Olignoclonal Bands and IgG Expression Level in Corebrospinal fluid of Patients with Severe Encephalitis
文章编号:
1671-7414（2025）03-164-05
作者:
惠 博1，陈 锟2，王韬涛2，康晓刚1,2，晁满香2
（1.空军军医大学第一附属医院神经内科，西安 710032；2.西京医院第九八六医院神经内科，西安 710054）
Author(s):
HUI Bo1，CHEN Kun2，WANG Taotao2，KANG Xiaogang1,2，CHAO Manxiang2
（1. Department of Neurology, the First Affiliated Hospital of Air Force Military Medical University, Xi’an 710032, China；2. Department of Neurology, the 986th Hospital of Xijing Hospital , Xi’an 710054，China）
关键词:
免疫球蛋白G; 寡克隆区带; 脑脊液; 重症脑炎
分类号:
R512.3；R446.14
DOI:
10.3969/j.issn.1671-7414.2025.03.030
文献标志码:
A
摘要:
目的探讨重症脑炎患者脑脊液寡克隆区带（OCB）阳性率及免疫球蛋白G（IgG）表达水平在疾病预后判断的价值。方法收集2016年1月~2020年10月在空军军医大学第一附属医院、西京九八六医院神经内科收治的699例脑炎患者作为研究对象，根据病情严重程度分为轻度（n=360）和重症（n=339）两组。采集入院时患者的脑脊液及血清样本，比较脑脊液细胞数、糖含量、IgG、脑脊液及血清寡克隆区带等指标差异。根据重症脑炎患者出院时的格拉斯哥预后（GOS）评分将患者分为预后良好组（n=259）和预后不良组（n=80），采用多因素Logistic回归分析影响患者预后的因素，分析脑脊液寡克隆区带和脑脊液IgG与重症脑炎患者预后间的相关性。绘制ROC曲线分析脑脊液IgG对预后的预测价值。结果与轻度脑炎患者比较，重症脑炎患者出现发热、肺部感染、癫痫持续状态、机械通气的比例更高，更易并发脑卒中和脑积水，差异具有统计学意义(χ2=5.319～245.179,均P<0.05)。两组相比，脑脊液有核细胞计数、脑脊液氯含量、脑脊液IgG含量与OCB阳性率的差异具有统计学意义(Z=-3.623，-4.875，-3.518,χ2=6.581，均P<0.05)。脑脊液寡克隆区带与脑脊液IgG是重症脑炎患者不良预后的独立危险因素（Waldχ2=7.295，11.179，均P<0.05）。绘制限制性立方样条图后发现，脑脊液IgG与不良预后之间存在线性关系。脑脊液IgG对不良预后预测ROC曲线下面积[AUC(95%CI]为0.754(0.632～0.876)。结论预后不良的重症脑炎患者脑脊液IgG含量及脑脊液寡克隆区带阳性率均高于预后良好患者，检测这两项指标对重症脑炎患者预后预测有一定参考价值。
Abstract:
Objective To investigate the clinical prognosis value of the positivity rate of oligoclonal bands(OCB) and immunoglobulin G (IgG)level of cerebrospinal fluid (CSF) in severe encephalitis. Methods A total of 699 cases of encephalitis patients admitted to the Department of Neurology of the First Affiliated Hospital of Air Force Military Medical University, and Xijing 986 Hospital from January 2016 to October 2020 were enrolled. According to the severity of their diseases, these patients were divided into a mild (n=360) group and a severe (n=339) group. CSF and serum samples were collected from the patient at the time of admission, and the differences in cerebrocyte count, glucose contem, glucose content, chlorine content, IgG of CSF and OCB of CSF and serum were compared. According to the GOS score of patients with severe encephalitis at discharge, the patients were divided into good prognosis group(n=259) and poor prognosis group(n=80), and multivariate Logistic regression analysis was used to analyze factors that affected the prognosis of severe encephalitis patients, and the correlation between the OCB and IgG of CSF and prognosis of patients with severe encephalitis.The predictive value of CSF IgG for the prognosis of patients with severe encephalitis was tested,and receiver operating characteristic (ROC) curve was plotted. Results Compared to patients with mild encephalitis, patients with severe encephalitis had a higher proportion of fever, pulmonary infection, status epilepticus, and mechanical ventilation, and were more likely to be complicated by stroke and hydrocephalus, and the differences were statistically significant (χ2=5.319 ～ 245.179, all P<0.05). There were significant differences in the positive rate of cerebrocyte count, chlorine content, IgG content and OCB in cerebrospinal fluid between the two groups (Z=-3.623, -4.875,-3.518, χ2=6.581, all P<0.05) . CSF OCB and CSF IgG were independent risk factors for poor prognosis in patients with severe encephalitis(Wald χ2=7.295, 0.001, all P<0.05). A restrictive cubic spline plot showed a linear relationship between CSF IgG and poor prognosis. The AUC(95%CI) of CSF IgG was 0.754(0.632～0.876). Conclusion The CSF IgG content and positive rate of CSF OCB in patients with severe encephalitis with poor prognosis are higher than those in patients with good prognosis, and detecting these two indicators has certain reference value for the prognosis prediction of patients with severe encephalitis.

参考文献/References:

[1] ELLUL M, SOLOMON T. Acute encephalitis - diagnosis and management[J]. Clinical Medicine (London, England), 2018, 18(2): 155-159.
[2] JOHNSON H J, KOSHY A A. Understanding neuroinflammation through central nervous system infections[J]. Current Opinion in Neurobiology, 2022, 76: 102619.
[3] SUNWOO J S, SHIN H R, LEE H S, et al. A hospital-based study on etiology and prognosis of bacterial meningitis in adults[J]. Scientific Reports, 2021, 11(1): 6028.
[4] HAGBERG L, ROSENSTEIN I, LYCKE J, et al. IgG and kappa free light chain CSF/serum indices: evaluating intrathecal immunoglobulin production in HIV infection in comparison with multiple sclerosis[J]. Clinical Chemistry and Laboratory Medicine, 2024, 62(10): 2024-2029.
[5] LO SASSO B, AGNELLO L, BIVONA G, et al. Cerebrospinal fluid analysis in multiple sclerosis diagnosis: an update[J]. Medicina (Kaunas, Lithuania), 2019, 55(6): 245.
[6] BRENNER J, MARIOTTO S, BASTIAANSEN A E M, et al. Predictive value of serum neurofilament light chain levels in anti-NMDA receptor encephalitis[J]. Neurology, 2023, 100(21): e2204-e2213.
[7] GAO Qinling, MA Yunxia, YUAN Dawei, et al. Micro RNA-125b in peripheral blood: a potential biomarker for severity and prognosis of Children with viral encephalitis[J]. Neurological Sciences,2017,38(8):1437-1444.
[8] GONG Zhe, ZHANG Chaopeng, LI Yanfei, et al. NLRP3 in the cerebrospinal fluid as a potential biomarker for the diagnosis and prognosis of Community-Acquired bacterial meningitis in adults[J]. Frontiers in Cellular and Infection Microbiology, 2021, 11: 803186.
[9] 李腾达,刘鹏,龙曙萍,等.隐球菌脑膜炎患者外周血单个核细胞PILRα升高及意义[J].现代检验医学杂志,2018,33(3):11-13. LI Tengda, LIU Peng, LONG Shuping, et al. Increasing expression of PILRα in peripheral blood mononuclear cells from patients with cryptococcal meningitis and its significance[J]. Journal of Modern Laboratory Medicine, 2018, 33(3): 11-13.
[10] 郑玉明,孙志宝,安庆华,等.中枢神经感染患者血脑屏障通透性与脑脊液IgG的相关性分析[J].中华医院感染学杂志,2016,26(8):1724-1726. ZHENG Yuming, SUN Zhibao, AN Qinghua, et al. Correlation between permeability of blood brain barrier and cerebrospinal fluid IgG in patients with central nervous system infection[J]. Chinese Journal of Nosocomiology, 2016, 26(8): 1724-1726.
[11] M?NNE C, TAKAYA A, YAMASAKI Y, et al. Salmonella SiiE prevents an efficient humoral immune memory by interfering with IgG+ plasma cell persistence in the bone marrow[J]. Proceedings of the National Academy of Sciences of the United States of America, 2019, 116(15): 7425-7430.
[12] OHYAGI M, IRIOKA T, OHKUBO T, et al. Intrathecal IgG synthesis and persistent inflammation are associated with white matter lesions in HIV-negative patients with cryptococcal meningoencephalitis[J]. Internal Medicine (Tokyo, Japan), 2019, 58(21): 3077-3082.
[13] NEGI N,DAS B K.Decoding intrathecal immunoglobulins and B cells in the CNS: their synthesis, function, and regulation[J]. International Reviews of Immunology, 2020, 39(2): 67-79.
[14] D?RR M, NISSEN G, S?HS K W, et al. CSF findings in acute NMDAR and LGI1 Antibody-Associated autoimmune encephalitis[J]. Neurol Neuroimmunol Neuroinflamm, 2021, 8(6): e1086.
[15] XUE Hongfei, GUO Xiaochan, JIANG Yushu, et al.Comparing clinical features, severity and prognosis of autoimmune encephalitis and with and without oligoclonal bands[J]. Frontiers in Neurology,2024,14: 1281276.
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备注/Memo

备注/Memo:
作者简介：惠博（1987-），女，硕士，主治医师，研究方向：神经系统感染与免疫疾病，E-mail：huiboo@126.com。
通讯作者：晁满香（1976-），女，学士，主治医师，研究方向：眩晕，颅内感染，E-mail：chaomanxiang@126.com。
更新日期/Last Update: 2025-05-15