Barstad Bjørn, Tveitnes Dag, Noraas Sølvi, Selvik Ask Ingvild, Saeed Maryam, Bosse Franziskus, Vigemyr Grete, Huber Ilka, Øymar Knut
From the *Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway; †Department of Medical Microbiology and ‡Department of Pediatrics, Hospital of Southern Norway Trust, Kristiansand, Norway; §Department of Pediatrics, Haukeland University Hospital, Bergen, Norway; ¶Department of Pediatrics, Haugesund Hospital, Haugesund, Norway; ‖Department of Pediatrics, Hospital of Southern Norway Trust, Arendal, Norway; and ††Department of Clinical Science, University of Bergen, Bergen, Norway.
Pediatr Infect Dis J. 2017 Dec;36(12):e286-e292. doi: 10.1097/INF.0000000000001669.
Current markers of Lyme neuroborreliosis (LNB) in children have insufficient sensitivity in the early stage of disease. The B-lymphocyte chemoattractant CXCL13 in the cerebrospinal fluid (CSF) may be useful in diagnosing LNB, but its specificity has not been evaluated in studies including children with clinically relevant differential diagnoses. The aim of this study was to elucidate the diagnostic value of CSF CXCL13 in children with symptoms suggestive of LNB.
Children with symptoms suggestive of LNB were included prospectively into predefined groups with a high or low likelihood of LNB based on CSF pleocytosis and the detection of Borrelia antibodies or other causative agents. CSF CXCL13 levels were compared between the groups, and receiver-operating characteristic analyses were performed to indicate optimal cutoff levels to discriminate LNB from non-LNB conditions.
Two hundred and ten children were included. Children with confirmed LNB (n=59) and probable LNB (n=18) had higher CSF CXCL13 levels than children with possible LNB (n=7), possible peripheral LNB (n=7), non-Lyme aseptic meningitis (n=12), non-meningitis (n=91) and negative controls (n=16). Using 18 pg/mL as a cutoff level, both the sensitivity and specificity of CSF CXCL13 for LNB (confirmed and probable) were 97%. Comparing only children with LNB and non-Lyme aseptic meningitis, the sensitivity and specificity with the same cutoff level were 97% and 83%, respectively.
CSF CXCL13 is a sensitive marker of LNB in children. The specificity to discriminate LNB from non-Lyme aseptic meningitis may be more moderate, suggesting that CSF CXCL13 should be used together with other variables in diagnosing LNB in children.
目前用于诊断儿童莱姆病神经型伯氏疏螺旋体病（LNB）的标志物在疾病早期的敏感性不足。脑脊液（CSF）中的B淋巴细胞趋化因子CXCL13可能有助于LNB的诊断，但在包括具有临床相关鉴别诊断的儿童的研究中，其特异性尚未得到评估。本研究的目的是阐明CSF CXCL13在有LNB症状儿童中的诊断价值。
前瞻性纳入有LNB症状的儿童，根据脑脊液细胞增多以及伯氏疏螺旋体抗体或其他病原体的检测结果，将其分为LNB可能性高或低的预定义组。比较两组之间的CSF CXCL13水平，并进行受试者工作特征分析，以确定区分LNB与非LNB情况的最佳临界值水平。
共纳入210名儿童。确诊LNB（n = 59）和可能LNB（n = 18）的儿童CSF CXCL13水平高于可能LNB（n = 7）、可能的外周LNB（n = 7）、非莱姆无菌性脑膜炎（n = 12）、非脑膜炎（n = 91）和阴性对照（n = 16）的儿童。以18 pg/mL作为临界值水平，CSF CXCL13对LNB（确诊和可能）的敏感性和特异性均为97%。仅比较LNB和非莱姆无菌性脑膜炎的儿童，相同临界值水平下的敏感性和特异性分别为97%和83%。
CSF CXCL13是儿童LNB的敏感标志物。将LNB与非莱姆无菌性脑膜炎区分开来的特异性可能较为一般，这表明在诊断儿童LNB时，CSF CXCL13应与其他变量一起使用。
