Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria.
Research Office, Biostatistics, Paracelsus Medical University, Salzburg, Austria.
J Neuroinflammation. 2019 Jan 19;16(1):13. doi: 10.1186/s12974-019-1405-8.
The chemokine CXCL13 is an intensively investigated biomarker in Lyme neuroborreliosis (LNB). Its role in other neuroinfections is increasingly recognized but less clear.
To determine the significance of CXCL13 in established central nervous system (CNS) infections other than LNB by matching cerebrospinal fluid (CSF) CXCL13 elevations with severity of the disease course.
We investigated 26 patients with bacterial (n = 10) and viral (n = 16; tick-borne encephalitis, n = 6; varicella zoster infection, n = 10) neuroinfections of whom CSF CXCL13 levels were available twice, from lumbar punctures (LP) performed at admission and follow-up. As outcome classification, we dichotomized disease courses into "uncomplicated" (meningitis, monoradiculitis) and "complicated" (signs of CNS parenchymal involvement such as encephalitis, myelitis, abscesses, or vasculitis). CXCL13 elevations above 250 pg/ml were classified as highly elevated.
Eight of 26 patients (31%) with both bacterial (n = 4) and viral (n = 4) neuroinfections had a complicated disease course. All of them but only 3/18 patients (17%) with an uncomplicated disease course had CSF CXCL13 elevations > 250 pg/ml at the follow-up LP (p < 0.001). At admission, 4/8 patients (50%) with a complicated disease course and 3/18 patients (17%) with an uncomplicated disease course showed CXCL13 elevations > 250 pg/ml. All four patients with a complicated disease course but only one with an uncomplicated disease course had sustained CXCL13 elevations at follow-up. Patient groups did not differ with regard to age, time since symptom onset, LP intervals, type of infections, and anti-pathogen treatments.
Our study revealed pronounced CXCL13 elevations in CSF of patients with severe disease courses of bacterial and viral neuroinfections. This observation indicates a role of CXCL13 in the CNS immune defense and points at an additional diagnostic value as biomarker for unresolved immune processes leading to or associated with complications.
趋化因子 CXCL13 是莱姆神经Borreliosis（LNB）中一种被深入研究的生物标志物。其在其他神经感染中的作用正逐渐被认识，但仍不明确。
通过将脑脊液（CSF）中 CXCL13 升高与疾病严重程度相匹配，确定除 LNB 以外的其他已确定中枢神经系统（CNS）感染中 CXCL13 的意义。
我们研究了 26 例细菌性（n=10）和病毒性（n=16；蜱传脑炎，n=6；水痘带状疱疹感染，n=10）神经感染患者，其中 26 例患者的 CSF CXCL13 水平在入院和随访时进行了两次腰椎穿刺（LP）时获得。作为疾病分类，我们将病程分为“单纯型”（脑膜炎、单神经根炎）和“复杂型”（脑炎、脊髓炎、脓肿或血管炎等中枢神经系统实质受累迹象）。将 CSF 中 CXCL13 水平高于 250pg/ml 归类为高度升高。
26 例患者中有 8 例（31%）患有细菌性（n=4）和病毒性（n=4）神经感染，其中 8 例（31%）的病程复杂。他们所有人但只有 18 例患者中的 3 例（17%）单纯型病程患者在随访 LP 时出现 CSF CXCL13 升高>250pg/ml（p<0.001）。入院时，8 例复杂型病程患者中有 4 例（50%）和 18 例单纯型病程患者中有 3 例（17%）的 CXCL13 升高>250pg/ml。所有 4 例复杂型病程患者和 1 例单纯型病程患者在随访时均持续存在 CXCL13 升高。两组患者在年龄、症状出现时间、LP 间隔、感染类型和针对病原体的治疗方面无差异。
我们的研究显示，细菌性和病毒性神经感染严重病程患者的 CSF 中存在明显的 CXCL13 升高。这一观察结果表明 CXCL13 在中枢神经系统免疫防御中发挥作用，并指出作为未解决免疫过程的生物标志物具有额外的诊断价值，这些免疫过程导致或与并发症相关。
