系统性红斑狼疮患者急性意识模糊状态（谵妄）脑脊液检测的诊断可靠性：白细胞介素6（IL-6）、IL-8、干扰素-α、IgG指数和Q-白蛋白

Diagnostic reliability of cerebral spinal fluid tests for acute confusional state (delirium) in patients with systemic lupus erythematosus: interleukin 6 (IL-6), IL-8, interferon-alpha, IgG index, and Q-albumin.

作者信息

Katsumata Yasuhiro, Harigai Masayoshi, Kawaguchi Yasushi, Fukasawa Chikako, Soejima Makoto, Takagi Kae, Tanaka Michi, Ichida Hisae, Tochimoto Akiko, Kanno Tokiko, Nishimura Katsuji, Kamatani Naoyuki, Hara Masako

机构信息

Institute of Rheumatology ,Tokyo Women's Medical University, Tokyo, Japan.

出版信息

J Rheumatol. 2007 Oct;34(10):2010-7. Epub 2007 Sep 15.

PMID:17896804

Abstract

OBJECTIVE

Acute confusional state (ACS) is an uncommon but severe central nervous system (CNS) syndrome in systemic lupus erythematosus (SLE) defined by clinical manifestations. To develop useful and reliable diagnostic tools for ACS, we evaluated the association of cerebral spinal fluid (CSF) tests with ACS and their predictive values for the diagnosis of ACS in SLE.

METHODS

We performed a prospective study using a cohort of 59 patients with SLE and compared those with and without ACS. Associations between ACS and each CSF test [interleukin 6 (IL-6), IL-8, interferon-alpha, IgG index, and Q-albumin] were statistically evaluated. Each patient underwent all CSF evaluations.

RESULTS

ACS was diagnosed in 10 patients (ACS group), SLE-related CNS syndromes except ACS in 13, and no CNS syndromes in 36 (non-CNS group). CSF IL-6 levels in the ACS group were significantly higher than those in the non-CNS group (p < 0.05). A positive IgG index (p = 0.028) was significantly associated with ACS. No other test showed a significant association with ACS. The positive and negative predictive values for the diagnosis of ACS in SLE were 80% and 85% for elevated CSF IL-6 levels (> or = 31.8 pg/ml), and 75% and 83% for the IgG index, respectively.

CONCLUSION

No single CSF test had sufficient predictive value to diagnose ACS in SLE, although CSF IL-6 levels and the IgG index showed statistical associations with ACS. Use of CSF tests combined with careful history and clinical examinations is recommended for proper diagnosis of ACS in SLE.

摘要

目的

急性意识模糊状态（ACS）是系统性红斑狼疮（SLE）中一种不常见但严重的中枢神经系统（CNS）综合征，由临床表现定义。为开发针对ACS的有用且可靠的诊断工具，我们评估了脑脊液（CSF）检测与ACS的关联及其对SLE中ACS诊断的预测价值。

方法

我们对59例SLE患者进行了一项前瞻性研究，并比较了有和没有ACS的患者。对ACS与每项CSF检测[白细胞介素6（IL-6）、IL-8、干扰素-α、IgG指数和Q-白蛋白]之间的关联进行了统计学评估。每位患者都接受了所有CSF评估。

结果

10例患者被诊断为ACS（ACS组），13例为除ACS外的SLE相关中枢神经系统综合征，36例无中枢神经系统综合征（非CNS组）。ACS组的CSF IL-6水平显著高于非CNS组（p < 0.05）。阳性IgG指数（p = 0.028）与ACS显著相关。没有其他检测显示与ACS有显著关联。对于SLE中ACS诊断的阳性和阴性预测值，CSF IL-6水平升高（≥31.8 pg/ml）时分别为80%和85%，IgG指数时分别为75%和83%。