Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, 600# Tianhe Road, Guangzhou, Guangdong Province 510630, China; Department of Neurology, Xiaolan People's Hospital of Zhongshan, 65#, Middle Section of Jucheng Avenue, Xiaolan, Zhongshan, Guangdong Province 528400, China.
Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St Louis, MO 63110, USA.
Mult Scler Relat Disord. 2024 May;85:105527. doi: 10.1016/j.msard.2024.105527. Epub 2024 Feb 27.
The differential diagnosis between autoimmune glial fibrillary acidic protein astrocytopathy (AGFAPA) mimicking tuberculous meningitis and tuberculous meningitis (TBM) remains challenging in clinical practice. This study aims to identify the clinical, laboratory parameters, and clinical score systems that may be helpful in differentiating AGFAPA from TBM.
Overall 22 AGFAPA patients who were initially misdiagnosed as TBM (AGFAPA-TBM) and 30 confirmed TBM patients were included. The clinical, laboratory, imaging parameters, Thwaites systems, and Lancet consensus scoring systems (LCSS) of all patients were reviewed. Logistic regression was employed to establish a diagnostic formula to differentiate AGFAPA-TBM from TBM. The receiver operating characteristic (ROC) curve was applied to determine the best diagnostic critical point of the formula.
Urinary retention was more frequent in AGFAPA-TBM patients (72.7% vs 33.3%, p = 0.012). A significantly lower ratio of T-SPOT. TB was noted in AGFAPA-TBM patients (9.1% vs 82.1%, p < 0.001). We found the LCSS was able to differentiate AGFAPA-TBM from TBM (AUC value 0.918, 95% CI=0.897-0.924). Furthermore, we set up a new scoring system with three variables: urinary retention, T-SPOT. TB, and cerebral imaging criteria in LCSS. The proposed diagnostic score ranges from -8 to 2, and a score of ≥ 0 was suggestive of AGFAPA-TBM (AUC value 0.938, 95% CI=0.878-0.951).
This study is the first to evaluate the Thwaites system and LCSS in AGFAPA-TBM and TBM. We provide an alternative diagnostic formula to differentiate AGFAPA-TBM from TBM and suggest testing for GFAP antibodies to avoid misdiagnosis when this scoring system meets AGFAPA-TBM.
自身免疫性胶质纤维酸性蛋白星形细胞瘤（AGFAPA）模仿结核性脑膜炎（TBM）与 TBM 之间的鉴别诊断在临床实践中仍然具有挑战性。本研究旨在确定有助于鉴别 AGFAPA 与 TBM 的临床、实验室参数和临床评分系统。
共纳入 22 例最初误诊为 TBM 的 AGFAPA 患者（AGFAPA-TBM）和 30 例确诊的 TBM 患者。回顾所有患者的临床、实验室、影像学参数、Thwaites 系统和 Lancet 共识评分系统（LCSS）。采用逻辑回归建立鉴别 AGFAPA-TBM 与 TBM 的诊断公式。应用受试者工作特征（ROC）曲线确定公式的最佳诊断临界值。
尿潴留在 AGFAPA-TBM 患者中更为常见（72.7%比 33.3%，p=0.012）。AGFAPA-TBM 患者的 T-SPOT.TB 比值明显较低（9.1%比 82.1%，p<0.001）。我们发现 LCSS 能够区分 AGFAPA-TBM 与 TBM（AUC 值 0.918，95%CI=0.897-0.924）。此外，我们建立了一个新的评分系统，包含三个变量：尿潴留、T-SPOT.TB 和 LCSS 中的脑影像学标准。该诊断评分范围为-8 至 2，评分≥0 提示为 AGFAPA-TBM（AUC 值 0.938，95%CI=0.878-0.951）。
本研究首次评估了 Thwaites 系统和 LCSS 在 AGFAPA-TBM 和 TBM 中的应用。我们提供了一种鉴别 AGFAPA-TBM 与 TBM 的替代诊断公式，并建议检测 GFAP 抗体，以避免在符合 AGFAPA-TBM 评分系统时误诊。
