Gao Daiquan, Lv Xue, Shen Zuoyao, Wang Huicong, Zhao Wenfeng, Wang Huang, Jin Xiukun, Tan Liuchen, Yin Lu, Wang Junhui, Yue Weihua, Wang Hongxing
Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China.
The First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453100, China.
Brain Sci. 2024 Aug 30;14(9):888. doi: 10.3390/brainsci14090888.
It is challenging to differentiate between central nervous system (CNS) virus infections and neurological autoimmune diseases in the emergency department. Considering their different pathogenesis, we assume they differ in neuropsychiatric symptoms and laboratory results. A total of 80 patients were included in this study, 50 with CNS virus infections and 30 with CNS autoimmune diseases, confirmed by a polymerase chain reaction (PCR) of cerebrospinal fluid (CSF). A binary logistic regression model and receiver operating characteristic (ROC) curve were employed to examine the discrimination between the two types of diseases based on neuropsychiatric symptoms and laboratory results. Compared to patients with neurological autoimmune diseases, patients with CNS virus infections had a higher incidence of abnormal behavior ( = 0.026) and abnormal sensation/thought ( = 0.029); higher total ( = 0.005), direct ( = 0.004), and indirect bilirubin ( = 0.004); and increased CSF cell ( = 0.01) and CSF white cell counts ( = 0.01). Patients with disturbance of consciousness and abnormal sensation/thought were 7.79-fold and 5.07-fold more likely to be diagnosed with CNS virus infections ( = 7.79, = 0.008; = 5.07, = 0.032). Each unit increase in blood indirect bilirubin concentration and CSF white cell counts increased the risk of developing CNS virus infections by 1.25-fold and 1.01-fold ( = 1.25, = 0.016; = 1.01, = 0.011). ROC analysis showed that the area under the curve was 88.0% ( < 0.001). Our study found that patients with CNS viral infections tend to have higher blood indirect bilirubin concentration, CSF leukocyte count, frequency of disorders of consciousness, and abnormal sensation and thought, which may help differentiate them from those with neurological autoimmune diseases.
在急诊科，区分中枢神经系统（CNS）病毒感染和神经自身免疫性疾病具有挑战性。考虑到它们不同的发病机制，我们推测它们在神经精神症状和实验室检查结果方面存在差异。本研究共纳入80例患者，其中50例为CNS病毒感染，30例为CNS自身免疫性疾病，均通过脑脊液（CSF）聚合酶链反应（PCR）确诊。采用二元逻辑回归模型和受试者工作特征（ROC）曲线，基于神经精神症状和实验室检查结果来检验这两种疾病之间的鉴别能力。与神经自身免疫性疾病患者相比，CNS病毒感染患者出现异常行为（P = 0.026）和异常感觉/思维（P = 0.029）的发生率更高；总胆红素（P = 0.005）、直接胆红素（P = 0.004）和间接胆红素（P = 0.004）水平更高；脑脊液细胞数（P = 0.01）和脑脊液白细胞计数（P = 0.01）增加。意识障碍和异常感觉/思维的患者被诊断为CNS病毒感染的可能性分别是7.79倍和5.07倍（P = 7.79，P = 0.008；P = 5.07，P = 0.032）。血液间接胆红素浓度和脑脊液白细胞计数每增加一个单位，发生CNS病毒感染的风险分别增加1.25倍和1.01倍（P = 1.25，P = 0.016；P = 1.01，P = 0.011）。ROC分析显示曲线下面积为88.0%（P < 0.001）。我们的研究发现，CNS病毒感染患者往往血液间接胆红素浓度、脑脊液白细胞计数、意识障碍频率以及异常感觉和思维更高，这可能有助于将他们与神经自身免疫性疾病患者区分开来。
