Matsui Makoto, Tanaka Keiko, Nagumo Fumio, Kuroda Yasuo
Department of Neurology, Utano National Hospital, Ukyo-ku, Kyoto 616-8255, Japan.
J Neurol Sci. 2004 Dec 15;227(1):139-47. doi: 10.1016/j.jns.2004.09.022.
To search for useful laboratory measures of central nervous system (CNS) immunity that may provide an accurate prognosis or clues regarding treatment choice, cerebrospinal fluid (CSF) samples were obtained from 14 consecutive patients with acute encephalitis during acute as well as convalescent or chronic stages, and then examined for surface antigen expressions by lymphocytes and the presence of antineuronal tissue antibodies as well as the levels of IgG-related parameters and proinflammatory cytokines, including IL-2, IL-6, IFN-gamma, and tumor necrosis factor-alpha (TNF-alpha). Seven patients with aseptic viral meningitis served as nonencephalitic controls. Eight of the 14 acute encephalitis patients recovered fully, and reductions in the percentages of CD4(+)CD29(+) helper inducer T cells and IL-2 receptor-positive CD4(+) cells were associated with early recovery and favorable outcome, respectively, whereas a low percentage of CD4(+)CD26(+) memory T cells during an acute stage was associated with an unfavorable outcome following adjunctive intravenous corticosteroid treatment. Further, three of the four encephalitis patients who exhibited autoantibodies had a poor prognosis. These findings suggest that CNS immunity status has an effect on prognosis, while flow cytometric analyses of CSF CD4(+) helper T cell subsets may serve as effective means of assessment.
为了寻找可能提供准确预后或治疗选择线索的中枢神经系统（CNS）免疫相关有用实验室指标，我们从14例连续的急性脑炎患者的急性期、恢复期或慢性期采集脑脊液（CSF）样本，检测淋巴细胞表面抗原表达、抗神经元组织抗体的存在以及IgG相关参数和促炎细胞因子水平，包括白细胞介素-2（IL-2）、白细胞介素-6（IL-6）、γ干扰素（IFN-γ）和肿瘤坏死因子-α（TNF-α）。7例无菌性病毒性脑膜炎患者作为非脑炎对照。14例急性脑炎患者中有8例完全康复，CD4(+)CD29(+)辅助诱导性T细胞百分比和IL-2受体阳性CD4(+)细胞百分比的降低分别与早期康复和良好预后相关，而急性期CD4(+)CD26(+)记忆性T细胞百分比低与辅助静脉注射皮质类固醇治疗后的不良预后相关。此外，出现自身抗体的4例脑炎患者中有3例预后不良。这些发现表明，中枢神经系统免疫状态对预后有影响，而脑脊液CD4(+)辅助性T细胞亚群的流式细胞术分析可能是有效的评估手段。
