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Abstract：
BACKGROUND: A case-control study was conducted to analyze the role of cerebrospinal fluid immunoglobulin in the differential diagnosis of autoimmune encephalitis and viral encephalitis in children.
METHODS: One hundred and twenty patients with autoimmune encephalitis (AE) treated in our hospital from February 2021 to February 2022 were included as the observation group (AE group). 100 patients with viral encephalitis (VE group) were selected as the control group. The clinical data of all patients were collected and analyzed retrospectively. Immunoglobulin G (IgG) and immunoglobulin A (IgA)in cerebrospinal fluid of the two patients were measured by immune turbidimetry. Immunoglobulin M (IgM), and the diagnostic value of immunoglobulin in cerebrospinal fluid (CSF) in patients with AE was analyzed by receiver working curve (ROC).
RESULTS: The level of IgG in the cerebrospinal fluid of the AE group was higher than that of the VE group, and the level of IgM was lower than that of the VE group, and the difference was statistically significant (P < 0.05). There was no significant difference in IgA levels between the two groups (P > 0.05). In terms of Magnetic Resonance (MR) features, the paraventricular, hippocampal, occipital and parietal lobes were more involved in AE patients, frontal and temporal lobes were more involved in VE patients, and paraventricular and occipital lobes were involved in MS. The proportion of bilateral extensive lesions in both groups was significantly higher than 50%. The proportions of patients in the AE group involving the lateral ventricle, insula, and parietal lobes were significantly higher than those in the VE group, and the proportions involving the basal ganglia, temporal lobes, and frontal lobes were significantly lower than those in the VE group, and the differences were statistically significant (All P < 0.05). The Area Under Curve (AUC) of IgG, IgA and IgM alone in the diagnosis of AE were 0.795(0.587-0.762), 0.602(0.502-0.631) and 0.627(0.534-0.708), respectively with the sensitivity values of 81.24% and 65.608, respectively and the specificity values of 65.08%, 57.54% and 75.01% respectively. The AUC of IgA + IgM in the diagnosis of AE was 0.733(0.617-0.849), and the sensitivity and specificity are 62.58% and 75.07% respectively. The AUC of IgA + IgG in the diagnosis of AE was 0.823(0.730-0.917), and the sensitivity and specificity were 81.24% and 67.54% respectively. The AUC of IgG + IgM in the diagnosis of AE was 0.886(0.814 ~ 0.958), and the sensitivity and specificity were 84.48% and 77.59% respectively. The AUC of IgA + IgM + IgG in the diagnosis of AE was 0.924 (0.868-0.981) with the sensitivity of 93.82%, and the specificity of 77.56%.
CONCLUSIONS: The level of immunoglobulin in cerebrospinal fluid can be used as an effective reference index for the diagnosis of AE. The combined detection of IgA, IgM and IgG can improve the accuracy, sensitivity and specificity of AE.
METHODS: One hundred and twenty patients with autoimmune encephalitis (AE) treated in our hospital from February 2021 to February 2022 were included as the observation group (AE group). 100 patients with viral encephalitis (VE group) were selected as the control group. The clinical data of all patients were collected and analyzed retrospectively. Immunoglobulin G (IgG) and immunoglobulin A (IgA)in cerebrospinal fluid of the two patients were measured by immune turbidimetry. Immunoglobulin M (IgM), and the diagnostic value of immunoglobulin in cerebrospinal fluid (CSF) in patients with AE was analyzed by receiver working curve (ROC).
RESULTS: The level of IgG in the cerebrospinal fluid of the AE group was higher than that of the VE group, and the level of IgM was lower than that of the VE group, and the difference was statistically significant (P < 0.05). There was no significant difference in IgA levels between the two groups (P > 0.05). In terms of Magnetic Resonance (MR) features, the paraventricular, hippocampal, occipital and parietal lobes were more involved in AE patients, frontal and temporal lobes were more involved in VE patients, and paraventricular and occipital lobes were involved in MS. The proportion of bilateral extensive lesions in both groups was significantly higher than 50%. The proportions of patients in the AE group involving the lateral ventricle, insula, and parietal lobes were significantly higher than those in the VE group, and the proportions involving the basal ganglia, temporal lobes, and frontal lobes were significantly lower than those in the VE group, and the differences were statistically significant (All P < 0.05). The Area Under Curve (AUC) of IgG, IgA and IgM alone in the diagnosis of AE were 0.795(0.587-0.762), 0.602(0.502-0.631) and 0.627(0.534-0.708), respectively with the sensitivity values of 81.24% and 65.608, respectively and the specificity values of 65.08%, 57.54% and 75.01% respectively. The AUC of IgA + IgM in the diagnosis of AE was 0.733(0.617-0.849), and the sensitivity and specificity are 62.58% and 75.07% respectively. The AUC of IgA + IgG in the diagnosis of AE was 0.823(0.730-0.917), and the sensitivity and specificity were 81.24% and 67.54% respectively. The AUC of IgG + IgM in the diagnosis of AE was 0.886(0.814 ~ 0.958), and the sensitivity and specificity were 84.48% and 77.59% respectively. The AUC of IgA + IgM + IgG in the diagnosis of AE was 0.924 (0.868-0.981) with the sensitivity of 93.82%, and the specificity of 77.56%.
CONCLUSIONS: The level of immunoglobulin in cerebrospinal fluid can be used as an effective reference index for the diagnosis of AE. The combined detection of IgA, IgM and IgG can improve the accuracy, sensitivity and specificity of AE.
摘要：
背景：进行了一项病例对照研究，以分析脑脊液免疫球蛋白在儿童自身免疫性脑炎和病毒性脑炎的鉴别诊断中的作用。
方法：将我院2021年2月至2022年2月收治的120例自身免疫性脑炎(AE组)患者作为观察组。选取100例病毒性脑炎患者(VE组)作为对照组。对所有患者的临床资料进行回顾性分析。采用免疫比浊法检测2例患者脑脊液中的免疫球蛋白G（IgG）和免疫球蛋白A（IgA）。免疫球蛋白M(IgM),采用受试者工作曲线(ROC)分析脑脊液(CSF)免疫球蛋白对AE患者的诊断价值。
结果：AE组脑脊液IgG水平高于VE组，IgM水平低于VE组，差异有统计学意义(P<0.05)。两组IgA水平比较差异无统计学意义(P>0.05)。在磁共振（MR）特征方面，室旁,海马,AE患者的枕叶和顶叶受累更多，额叶和颞叶在VE患者中更受累，MS累及室旁叶和枕叶。两组双侧广泛病变的比例均明显高于50％。AE组涉及侧脑室的患者比例，脑岛,顶叶明显高于VE组，以及涉及基底神经节的比例，颞叶,额叶明显低于VE组，差异均有统计学意义(均P<0.05)。IgG的曲线下面积(AUC),单独诊断AE的IgA和IgM为0.795(0.587-0.762),0.602（0.502-0.631）和0.627（0.534-0.708），敏感性值分别为81.24%和65.608,特异性值分别为65.08%,分别为57.54%和75.01%。IgA+IgM诊断AE的AUC为0.733(0.617-0.849),敏感性和特异性分别为62.58%和75.07%。IgA+IgG诊断AE的AUC为0.823(0.730-0.917),敏感性和特异性分别为81.24%和67.54%。IgG+IgM诊断AE的AUC为0.886(0.814~0.958),敏感性和特异性分别为84.48%和77.59%。IgA+IgM+IgG诊断AE的AUC为0.924(0.868-0.981),灵敏度为93.82%,特异性为77.56%。
结论：脑脊液免疫球蛋白水平可作为诊断AE的有效参考指标。联合检测IgA,IgM和IgG可以提高准确性，AE的敏感性和特异性。
方法：将我院2021年2月至2022年2月收治的120例自身免疫性脑炎(AE组)患者作为观察组。选取100例病毒性脑炎患者(VE组)作为对照组。对所有患者的临床资料进行回顾性分析。采用免疫比浊法检测2例患者脑脊液中的免疫球蛋白G（IgG）和免疫球蛋白A（IgA）。免疫球蛋白M(IgM),采用受试者工作曲线(ROC)分析脑脊液(CSF)免疫球蛋白对AE患者的诊断价值。
结果：AE组脑脊液IgG水平高于VE组，IgM水平低于VE组，差异有统计学意义(P<0.05)。两组IgA水平比较差异无统计学意义(P>0.05)。在磁共振（MR）特征方面，室旁,海马,AE患者的枕叶和顶叶受累更多，额叶和颞叶在VE患者中更受累，MS累及室旁叶和枕叶。两组双侧广泛病变的比例均明显高于50％。AE组涉及侧脑室的患者比例，脑岛,顶叶明显高于VE组，以及涉及基底神经节的比例，颞叶,额叶明显低于VE组，差异均有统计学意义(均P<0.05)。IgG的曲线下面积(AUC),单独诊断AE的IgA和IgM为0.795(0.587-0.762),0.602（0.502-0.631）和0.627（0.534-0.708），敏感性值分别为81.24%和65.608,特异性值分别为65.08%,分别为57.54%和75.01%。IgA+IgM诊断AE的AUC为0.733(0.617-0.849),敏感性和特异性分别为62.58%和75.07%。IgA+IgG诊断AE的AUC为0.823(0.730-0.917),敏感性和特异性分别为81.24%和67.54%。IgG+IgM诊断AE的AUC为0.886(0.814~0.958),敏感性和特异性分别为84.48%和77.59%。IgA+IgM+IgG诊断AE的AUC为0.924(0.868-0.981),灵敏度为93.82%,特异性为77.56%。
结论：脑脊液免疫球蛋白水平可作为诊断AE的有效参考指标。联合检测IgA,IgM和IgG可以提高准确性，AE的敏感性和特异性。
