Qiao Shan, Li Haiyun, Cui Caisan, Zhang Chong, Wang Aihua, Jiang Wenjing, Zhang Shanchao
Department of Neurology, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, Jinan, People's Republic of China.
Department of Medical Genetics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.
J Inflamm Res. 2024 Mar 18;17:1765-1776. doi: 10.2147/JIR.S383161. eCollection 2024.
CSF inflammation in subtypes of antibody-defined autoimmune encephalitis (AE) ranges in intensity from moderate to severe. In a retrospective, cross-sectional study, we characterized CSF findings in Chinese patients with anti-N-methyl-D-aspartate receptor encephalitis (NMDAR-E), anti-leucine-rich glioma-inactivated 1 encephalitis (LGI1-E), and anti-gamma aminobutyric acid-B receptor encephalitis (GABABR-E).
The AE cases, including 102 NMDAR-E, 68 LGI1-E and 15 GABABR-E, were included. CSF inflammatory parameters consisted primarily of CSF leukocytes, oligoclonal bands (OCBs), and CSF/serum albumin ratios (Q). Ten serum cytokines were evaluated in order to classify AE subtypes.
88% of NMDAR-E, 80% of GABABR-E, and 51% of LGI1-E patients had aberrant CSF features. In NMDAR-E, the CSF leukocyte count, CSF protein concentration, and age-adjusted Q were significantly higher than in LGI1-E, but did not differ from GABABR-E. Blood-CSF barrier dysfunction was less common in NMDAR-E patients with >40 years old. On admission, inflammatory CSF response was more prevalent in NMDAR-E patients with a higher CASE score. With age <60 years, CSF inflammatory changes were less frequent in LGI1-E patients, but more common in GABABR-E patients. MCP-1, IL-10, IL-1β, and IL-4 were potential classifiers for NMDAR-E, LGI1-E, and GABABR-E, and correlated substantially with CSF leukocyte count and Q.
Subtype-specific patterns are formed by the various inflammatory CSF parameters in NMDAR-E, LGI1-E, and GABABR-E, and their correlation with disease severity, age, and disease duration. CSF inflammatory characteristics associated with MCP-1, IL-10, IL-1β, and IL-4 may be potential immunopathogeneses targeting markers for these AE subtypes.
抗体介导的自身免疫性脑炎（AE）各亚型的脑脊液炎症程度从中度到重度不等。在一项回顾性横断面研究中，我们对中国抗N-甲基-D-天冬氨酸受体脑炎（NMDAR-E）、抗富含亮氨酸胶质瘤失活1蛋白脑炎（LGI1-E）和抗γ-氨基丁酸B型受体脑炎（GABABR-E）患者的脑脊液检查结果进行了特征分析。
纳入AE病例，包括102例NMDAR-E、68例LGI1-E和15例GABABR-E。脑脊液炎症参数主要包括脑脊液白细胞、寡克隆带（OCB）和脑脊液/血清白蛋白比值（Q）。评估了10种血清细胞因子以对AE亚型进行分类。
88%的NMDAR-E、80%的GABABR-E和51%的LGI1-E患者有异常脑脊液特征。在NMDAR-E中，脑脊液白细胞计数、脑脊液蛋白浓度和年龄校正后的Q显著高于LGI1-E，但与GABABR-E无差异。40岁以上的NMDAR-E患者血脑屏障功能障碍较少见。入院时，CASE评分较高的NMDAR-E患者脑脊液炎症反应更普遍。年龄<60岁时，LGI1-E患者脑脊液炎症变化较少见，但在GABABR-E患者中更常见。MCP-1、IL-10、IL-1β和IL-4是NMDAR-E、LGI1-E和GABABR-E的潜在分类指标，且与脑脊液白细胞计数和Q显著相关。
NMDAR-E、LGI1-E和GABABR-E中各种脑脊液炎症参数形成了亚型特异性模式，且它们与疾病严重程度、年龄和病程相关。与MCP-1、IL-10、IL-1β和IL-4相关的脑脊液炎症特征可能是这些AE亚型潜在的免疫发病机制靶向标志物。
