Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Eur J Neurol. 2021 Mar;28(3):965-973. doi: 10.1111/ene.14600. Epub 2020 Nov 30.
Elevated cerebrospinal fluid (CSF) total protein in patients with acute ascending paresis is indicative of Guillain-Barré syndrome (GBS). Recent studies showed that the outdated, but still widely used upper reference limit (URL) for CSF total protein of 0.45 g/L leads to false-positive results, mainly as a result of lack of age-adjustment. The objective of this study was to assess the frequency of increased CSF total protein in adult GBS patients according to a new age-dependent URL.
Patients with GBS treated at the Medical University of Innsbruck between 2000 and 2018 were included in this study. Demographic, clinical, electrophysiological and CSF data were obtained from patients' medical charts. Frequency of increased CSF total protein depending on disease duration was compared using the conventional URL of 0.45 g/L and the age-dependent URL.
Ninety-seven patients with GBS aged 57 ± 18 years, comprising 38% women, underwent CSF sampling within a median of 6 days after symptom onset. The median CSF total protein concentration was 0.65 g/L and correlated with disease duration. Overall, 74% of patients had elevated CSF total protein levels using the conventional URL, as opposed to 52% applying the age-dependent URL. At 0-3, 4-7, 8-14 and >14 days after disease onset, elevated CSF total protein was found in 46%, 84%, 78% and 100% of patients using the conventional URL, and in 32%, 53%, 65% and 64% of patients using the age-dependent URL. In multivariate analysis, significant predictors of elevated CSF total protein were disease duration and the demyelinating GBS variant. Similar results were obtained for CSF/serum albumin quotient (Q ).
Fewer true-positives for CSF total protein and Q must be considered in suspected GBS, especially in the early disease course.
急性上升性瘫痪患者脑脊液（CSF）总蛋白升高提示格林-巴利综合征（GBS）。最近的研究表明，陈旧但仍广泛使用的 CSF 总蛋白上限参考值（URL）0.45g/L 会导致假阳性结果，主要是由于缺乏年龄调整。本研究旨在根据新的年龄相关 URL 评估成人 GBS 患者 CSF 总蛋白升高的频率。
纳入 2000 年至 2018 年在因斯布鲁克医科大学接受治疗的 GBS 患者。从患者病历中获取人口统计学、临床、电生理学和 CSF 数据。使用常规 URL 0.45g/L 和年龄相关 URL 比较疾病持续时间与 CSF 总蛋白升高的频率。
97 例 GBS 患者年龄 57±18 岁，女性占 38%，症状发作后中位 6 天内进行 CSF 采样。CSF 总蛋白浓度中位数为 0.65g/L，与疾病持续时间相关。总体而言，74%的患者使用常规 URL 时 CSF 总蛋白水平升高，而使用年龄相关 URL 时则为 52%。在发病后 0-3、4-7、8-14 和>14 天，使用常规 URL 时分别有 46%、84%、78%和 100%的患者 CSF 总蛋白升高，而使用年龄相关 URL 时则有 32%、53%、65%和 64%的患者 CSF 总蛋白升高。多变量分析显示，CSF 总蛋白升高的显著预测因素是疾病持续时间和脱髓鞘 GBS 变异型。CSF/血清白蛋白比值（Q）也有类似结果。
疑似 GBS 时，CSF 总蛋白和 Q 的假阳性率应较低，尤其是在疾病早期。
