自身免疫性脑炎患儿及肺炎支原体脑炎患儿外周血淋巴细胞免疫、体液免疫表达水平及意义  

The expression and significance of peripheral lymphocyte immunity and humoral immunity in children with autoimmune encephalitis and children with mycoplasma encephalitis

作　　者：陈芳[1] 孙素真[1] 杜雅坤[1] 刘学芳 李静洁[1] Chen Fang;Sun Suzhen;Du Yakun;Liu Xuefang;Li Jingjie(Department of Neurology,Hebei Children′s Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院神经内一科,石家庄050031

出　　处：《中国医师进修杂志》2020年第10期922-926,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的:探讨自身免疫性脑炎患儿及肺炎支原体脑炎患儿外周血淋巴细胞免疫、体液免疫表达水平及意义。方法:选取2018年7月至2019年7月河北省儿童医院收治的自身免疫性脑炎患儿52例(自身免疫性脑炎组)及肺炎支原体脑炎患儿68例(肺炎支原体脑炎组),选取同期接受治疗的43例肺炎支原体感染患儿作为对照组。采用全自动生化分析仪检测血清免疫球蛋白(IgA、IgG、IgM)水平,采用流式细胞仪测定外周血清T淋巴细胞亚群(CD^3+、CD^4+、CD^8+、CD^4+/CD^8+),并进行比较。采用受试者工作特征(ROC)曲线分析血清免疫球蛋白、T淋巴细胞亚群指标对自身免疫性脑炎及肺炎支原体脑炎的临床鉴别诊断价值。结果:三组患儿血清IgA、IgM水平比较差异有统计学意义(P<0.05),肺炎支原体脑炎组患儿血清IgA、IgM水平显著高于对照组及自身免疫性脑炎组[(1.64±0.56)g/L比(1.23±0.48)和(0.82±0.25)g/L、(1.81±0.45)g/L比(1.56±0.48)和(1.12±0.34)g/L](P<0.05),但是三组患者血清IgG水平比较差异无统计学意义(P>0.05)。肺炎支原体脑炎组外周血CD^4+、CD^8+高于自身免疫性脑炎组和对照组[(31.21±3.86)%比(28.76±3.57)%和(26.58±3.49)%、(26.86±1.89)%比(25.90±2.16)%和(24.71±2.46)%](P<0.05);但是三组患者CD^4+/CD^8+比值比较差异无统计学意义(P>0.05)。血清IgA、IgM、CD^3+、CD^8+、CD^4+及五项联合诊断自身免疫性脑炎及肺炎支原体脑炎的曲线下面积(AUC)分别为0.971、0.835、0.833、0.631、0.706及1.000;最佳临界值分别为1.255 g/L、1.465 g/L、57.435%、26.456%、29.750%及1.858;灵敏度分别为100.0%、64.7%、95.6%、92.6%、69.1%及100.0%,特异度分别为95.6%、57.0%、57.1%、23.4%、36.4%及100.0%。结论:自身免疫性脑炎患儿血清IgA、IgM及外周血清CD^3+、CD^4+、CD^8+表达水平显著低于肺炎支原体脑炎患儿,且IgA、IgM、CD^3+、CD^8+、CD^4+对自身免疫性脑炎和肺炎支原体脑炎具有较高的鉴别诊Objective To investigate the expression level and significance of peripheral lymphocyte immunity and humoral immunity in children with autoimmune encephalitis and children with mycoplasma encephalitis.Methods From July 2018 to July 2019,52 children with autoimmune encephalitis(autoimmune encephalitis group)and 68 children with mycoplasma encephalitis(mycoplasma encephalitis group)in Hebei Children′s Hospital were enrolled,and 43 children with mycoplasma infection who were treated at the same time were selected as control group.Serum immunoglobulin(IgA,IgG,IgM)levels were detected using a fully automated biochemical analyzer,and peripheral T-lymphocyte subsets(CD^3+,CD^4+,CD^8+,CD^4+/CD^8+)levels were measured using flow cytometry.The receiver operating characteristic(ROC)curve was used to analyze the clinical differential diagnostic value of serum immunoglobulin and T lymphocyte subsets indicators for autoimmune encephalitis and mycoplasma encephalitis.Results The levels of serum IgA,IgM in three groups had significant differences(P<0.05);the levels of serum IgA,IgM in mycoplasma encephalitis group were significantly higher than those in autoimmune encephalitis group and control group[(1.64±0.56)g/L vs.(1.23±0.48),(0.82±0.25)g/L;(1.81±0.45)g/L vs.(1.56±0.48),(1.12±0.34)g/L](P<0.05);the level of IgG in three groups has no significant difference(P>0.05).The levels of CD^4+,CD^8+in mycoplasma encephalitis group were significantly higher than those in autoimmune encephalitis group and control group[(31.21±3.86)%vs.(28.76±3.57)%,(26.58±3.49)%;(26.86±1.89)%vs.(25.90±2.16)%,(24.71±2.46)%](P<0.05);the level of CD^4+/CD^8+in three groups has no significant difference(P>0.05).The areas under the curve of serum IgA,IgM,CD^3+,CD^8+,CD^4+and five combined diagnosis were 0.971,0.835,0.833,0.631,0.706 and 1.000.The optimal critical values were 1.255 g/L,1.465 g/L,57.435%,26.456%,29.750%and 1.858.The sensitivity was 100.0%,64.7%,95.6%,92.6%,69.1%and 100.0%,and the specificity was 95.6%,57.0%,57.1%,23.4%,36.4%and 10

关 键 词：自身免疫性脑炎 肺炎支原体脑炎 细胞免疫 体液免疫 

分 类 号：R742.9[医药卫生—神经病学与精神病学] R725.6[医药卫生—临床医学]