The Clinical Research Of Cerebrospinal Fluid Immunoglobulins In Children With Viral Encephalitis And Autoimmune Encephalitis

Objective: Viral encephalitis(VE)and autoimmune encephalitis(AE)are two most common encephalitis in childhood.However,there is high rate of misdiagnose in the early course of the disease due to their similar clinical manifestations and laboratory investigations.At present,there is still a lack of effective clinical index for the early diagnose of autoimmune encephalitis.Intracranial immune response can be induced by viral infections and autoimmune diseases but with different type and degree.Cerebrospinal fluid(CSF)immunoglobulins are markers of intracranial humoral immune response.To evaluate the difference of intracranial response between VE and AE as well as the value of CSF immunoglobulins as diagnostic marker,we concluded the level of cerebrospinal fluid immunoglobulins,clinical characters,investigations and prognosis of children with VE and AE.We retrospectively analyzed the levels of CSF immunoglobulins in children with VE and AE,aiming to explore the clinical value of CSF immunoglobulins in children with viral encephalitis and autoimmune encephalitis.Method: We chose 162 cases of viral encephalitis and 23 cases of autoimmune encephalitis from our department between January 2016 and March 2019,collecting their clinical manifestation,peripheral cell-mediated immunity,humoral immunity,electroencephalogram(EEG),cranial Magnetic Resonance Imaging(MRI)and pathogens.Meanwhile,we evaluate their neurological severity scores and prognosis according to modified Rankin Scale.Then we compared the distribution of cerebrospinal fluid immunoglobulins in VE and AE and concluded the clinical significance of CSF immunoglobulins in diagnosing VE and AE and predicting prognosis.Result:1.Viral encephalitisIn the viral encephalitis group,the level of CSFIg G,CSFIg A and CSFIg M increased in the normal CSF cells group compared with the normal group,and the difference was statistically significant(P<0.01).The distribution of CSFIg G,CSFIg A and CSFIg M in the children with increased CSF protein group were higher than that in the normal group,and the difference was statistically significant(P<0.01).There was no significant difference in the distribution of CSF immunoglobulins between the immunotherapy group and the non-immunotherapy group(P>0.05).The levels of CSFIg G and CSFIg A in the viral meningoencephalitis group were higher than those in the viral meningoencephalitis group,and the distribution difference was statistically significant(P<0.01).The level of CSFIg M in children with severe viral encephalitis was higher than that in children with mild cases,and the distribution difference was statistically significant.The sensitivity and specificity of mRS for assessing the disease severity of viral encephalitis for mild cases were 97.1% and 65.5%respectively,and those of mRS for assessing the severity of viral encephalitis for severe cases were 65.5% and 97.1% respectively.2.Autoimmune encephalitisThe level of CSFIg G,CSFIg A and CSFIg M in the confirmed antiNMDAR encephalitis group were not statistically different from those in the possible AE group.There was no statistical difference in the distribution of CSFIg G,CSFIg A and CSFIg M between the immunotherapy group and the non-immunotherapy group.The level of CSFIg G and CSFIg A in the autoimmune encephalitis group were higher than those in the severe viral encephalitis group,and the distribution difference was statistically significant3.Clinical diagnostic value of cerebrospinal fluid immunoglobulinsAccording to the ROC curve of CSF immunoglobulins in diagnosing AE,the diagnostic efficacy of the CSF immunoglobulins in differentiating viral encephalitis and autoimmune encephalitis as follows: The AUC of CSFIg G was 0.668(95%CI0.538-0.797)and the cut-off value was 16mg/L.The AUC of CSFIg A was 0.723(95%CI0.638-0.808)and the cut-off value was 1 mg/L.The AUC of CSFIg M was 0.703(95%CI0.601-0.805)and the cut-off value was 0.4mg /L.According to the ROC curve of CSF immunoglobulins in evaluating prognosis of VE,the diagnostic efficacy of the CSF immunoglobulins as follows: The AUC of CSFIg G was 0.667(95%CI0.425-0.910),and the cut-off value was 26.9 mg/L.The AUC of CSFIg A was 0.593(95%CI0.387-0.799),and the cut-off value was 1.44mg/L.The AUC of CSFIg M was 0.748(95%CI0.568-0.928),and the cut-off value was 2.78mg/L.Conclusion:(1)mRS has clinical value in assessing the disease severity of children with viral encephalitis.(2)CSF immunoglobulin has efficacy in evaluating the prognosis of viral encephalitis,among which CSFIg M is the most effective in predicting the prognosis of viral encephalitis.(3)CSF immunoglobulins have diagnostic efficacy in differentiating viral encephalitis and autoimmune encephalitis,among which the efficacy of CSFIg A in diagnosing autoimmune encephalitis is the most.