Clinical Center of Emerging and Vector-borne Infections (CCEVI), Department of Infectious Diseases, Odense University Hospital, J.B.Winsloews vej 4, 5000, Odense C, Denmark.
Clinical Institute, Research Unit for Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Eur J Clin Microbiol Infect Dis. 2020 Aug;39(8):1461-1470. doi: 10.1007/s10096-020-03861-4. Epub 2020 Mar 14.
The role of CXCL13 as a marker of Lyme neuroborreliosis (LNB) is under investigation, and CXCL13 is not part of routine diagnostics in suspicion of LNB. Our aim was to find the optimal cut-off value of CXCL13 for LNB in a Danish population and to investigate the role of CXCL13 both in early LNB and as a discriminatory marker between LNB and other neuroinflammatory disorders. We conducted a retrospective cross-sectional study including all patients with a cerebrospinal CXCL13 test performed at the Department of Clinical Immunology, Odense University Hospital, Denmark, between 1 January 2015 and 31 December 2018. We included 619 patients, of which 51 had definite LNB, 14 patients had possible LNB with neurological symptoms suggestive of LNB and pleocytosis but no intrathecal Borrelia antibodies, eight patients had prior LNB and 546 had no LNB. With an optimal CXCL13 cut-off of 49 ng/L we found a sensitivity of 100% and specificity of 94% (AUC 0.988, 95% CI 0.980-0.996) when patients treated with antibiotics prior to lumbar puncture were excluded (n = 130). All patients with possible LNB had a CXCL13 value above the cut-off value; 18/546 patients (3.3%) without LNB had a CXCL13 value ≥ 50 ng/L. While CXCL13 cannot be used as a stand-alone test, it can be used as a reliable additional marker in treatment-naive patients suspected of LNB. CXCL13 can be used to monitor treatment response in LNB patients.
CXCL13 作为莱姆神经Borreliosis（LNB）标志物的作用正在研究中，并且 CXCL13 并非怀疑 LNB 时常规诊断的一部分。我们的目的是在丹麦人群中找到 CXCL13 对 LNB 的最佳截止值，并研究 CXCL13 在早期 LNB 中的作用以及作为 LNB 与其他神经炎症性疾病之间的鉴别标志物的作用。我们进行了一项回顾性横断面研究，纳入了 2015 年 1 月 1 日至 2018 年 12 月 31 日期间在丹麦奥登塞大学医院临床免疫学系进行脑脊髓 CXCL13 检测的所有患者。我们纳入了 619 例患者，其中 51 例有明确的 LNB，14 例有疑似 LNB 的神经系统症状和细胞增多症，但无鞘内 Borrelia 抗体，8 例有既往 LNB，546 例无 LNB。在排除腰椎穿刺前接受抗生素治疗的 130 例患者（n=130）后，当 CXCL13 截断值为 49ng/L 时，我们发现其敏感性为 100%，特异性为 94%（AUC 0.988，95%CI 0.980-0.996）。所有疑似 LNB 的患者的 CXCL13 值均高于截断值；546 例无 LNB 的患者中，有 18 例（3.3%）的 CXCL13 值≥50ng/L。虽然 CXCL13 不能作为独立的测试方法，但它可以作为怀疑未经治疗的 LNB 患者的可靠附加标志物。CXCL13 可用于监测 LNB 患者的治疗反应。
