目的 探究自身免疫性脑炎(autoimmune encephalitis,AE)患者的脑脊液(cerebral spinal fluid,CSF)细胞学特点.方法 回顾性收集济宁医学院附属医院2016年1月至2019年6月收治的28例确诊AE患者的脑脊液常规、生化、细胞学、颅内压等结果,分析其特点及其与疾病严重程度的相关性.结果 28例AE患者中,抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎11例,抗富含亮氨酸胶质瘤失活蛋白1(leucine-rich glioma-inactivated protein 1,LGI1)抗体相关脑炎 13 例,抗 γ-氨基丁酸 B 型受体(γ-aminobutyric acid type B receptor,GABABR)抗体相关脑炎4例.CSF检查中,颅内压中位数(四分位数间距)为127.5(41.0)mmH2O,蛋白中位数(四分位数间距)为0.48(0.15)g/L,糖和氯化物基本正常.28例中,7例患者CSF常规检查可见炎性反应;9例患者CSF细胞学检查可见炎性反应,其中6例为抗NMDAR脑炎患者,炎性反应类型均为淋巴细胞炎性反应,轻、中、重度炎性反应分别为4、3、2例,检测到激活淋巴细胞4例,浆细胞2例.CSF细胞学检查炎性细胞阳性率高于CSF常规检查炎性细胞阳性率(P=0.02),抗NMDAR脑炎患者CSF细胞学的炎性反应程度与患者入院时的改良Rankin评分(mRS)呈正相关(r=0.23,P＜0.01).结论 本组AE患者CSF细胞学检查多表现为淋巴细胞炎性反应,抗NMDAR脑炎患者的CSF炎性反应阳性率最高,炎性反应程度最重.与CSF常规检查相比,CSF细胞学能够更敏感地发现AE的炎性反应,可作为诊断AE及评估疾病严重程度的重要方法.
Characteristics of cerebrospinal fluid cytology in 28 cases of autoimmune encephalitis
Objective To investigate the cytological characteristics of cerebrospinal fluid(CSF)in patients with autoimmune encephalitis(AE).Methods The cerebrospinal fluid cytology,intracranial pressure,routine,and biochemical results of 28 patients with confirmed AE,who admitted to the Affiliated Hospital of Jining Medical College from January 2016 to June 2019,were retrospectively collected.Their characteristics and its correlation with disease severity were analyzed.Results Among the 28 patients with AE,11 cases were anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis,13 cases were anti-leucine rich glioma inactivated protein 1(LGI1)antibody associated encephalitis,and 4 cases were γ-aminobutyric acid type B receptor(GABABR)antibody associated encephalitis.In routine CSF examination,the median intracranial pressure was 127.5[interquartile range(IQR)41.0]mmH2O,and the median protein was 0.48(IQR 0.15)g/L,glucose and chloride were generally normal.Inflammatory reactions were observed in CSF tests of 7 patients,CSF cytology showed inflammatory reactions in 9 patients,including 6 patients with NMDAR encephalitis.The types of inflammatory reactions were all lymphocytic inflammatory reactions,with mild,moderate,and severe inflammatory reactions in 4,3,and 2 cases,respectively.Activated lymphocytes were detected in 4 cases,and plasma cells in 2 cases.The positive rate of CSF cytology was higher than the routine positive rate of CSF(P=0.02).The degree of inflammatory reaction of CSF cytology in patients with anti NMDAR encephalitis was positively correlated with the modified Rankin scale(mRS)of the patient at admission(r=0.23,P＜0.01).Conclusions CSF cytology in patients with AE is mostly characterized by lymphocytic inflammatory reactions.Patients with anti NMDAR encephalitis have the highest positive rate of CSF inflammatory reactions and the most severe inflammatory reactions.Compared with CSF routine,CSF cytology is more sensitive for detecting the inflammatory response of AE,and can be used as an important method for diagnosing AE and evaluating the severity of the disease.
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