Diagnostic Significance Of Cytokines Combined With Microcirculation In The Diagnosis Of Central Neuropsychiatric Lupus

Objective:To explore the clinical significance of combined detection of cytokines(IL-2R,IL-1?,IL-6,IL-8,IL-10,TNF-?)and microcirculation(hyperthyroidism and bulbar conjunctiva)in central neuropsychiatric lupus.Methods:Screening of 50 cases of CNS-NPSLE,50 cases of non-NPSLE without neuro-psychiatric symptoms,and 30 cases of intracranial infection were collected from December 2016 to December 2018.The serum and cerebrospinal fluid(CSF)of the three groups were collected,and the levels of IL-2R,IL-1?,IL-6,IL-8,IL-10 and TNF-? in serum and CSF were determined by chemiluminescence method.Hyperthyr-oidism and conjunctival microcirculation were performed in all three groups.The cytokine levels and microcirculation scores of each group were compared.The quantitative indicators list the mean and standard deviation,and the classification indicators list the number of cases and percentages.Measurement data were analyzed by one-way analysis of variance and post hoc comparison.The count data was analyzed by ?2 test.If the P value was less than or equal to 0.05,the difference was considered statistically significant.The cytokine and microcirculation scores were analyzed by ROC curve to distinguish the value of each group of patients.Results:(1)There was no significant difference in age and gender between CNS-NPSLE group,non-NPSLE group and intracranial infection group(P>0.05).(2)There were 10 kinds of neuropsychiatric symptoms in the CNS-NPSLE group.Three patients were diagnosed as CNS-NPSLE because of the initial neuropsychiatric symptoms and twenty-five patients had neuropsychiatric symptoms during hospitalization.Twenty-six patients developed two or more neuropsychiatric symptoms.The most common neuropsychiatric symptoms were 23 cases of seizures,followed by 20 cases of headache,14 cases of acute disturbance of consciousness,11 cases of mental illness,9 cases of mood disorder,8 cases of cerebrovascular disease,8 cases of cognitive impairment,7 cases of anxiety disorder,5 cases of demyelinating disease and 2 cases of aseptic meningitis.(3)The levels of IL-6 and IL-8 in cerebrospinal fluid in CNS-NPSLE group were significantly higher than those in non-NPSLE group(P<0.001),but there was no significant difference between them and intracranial infection group(P>0.05).(4)The levels of IL-6 and IL-8 in cerebrospinal fluid were above 0.8 in the ROC curve when identifying CNS-NPSLE and non-NPSLE groups.(5)There was no significant difference in the levels of IL-2R,IL-1?,IL-10 and TNF-? in cerebrospinal fluid of each group(P>0.05).(6)There was no significant difference in serum cytokine levels between all the three groups(P>0.05).(7)The total score of hyperthyroidism microcirculation in CNS-NPSLE group was significantly higher than that in intracranial infection group(P<0.001),but there was no significant difference with non-NPSLE group(P>0.05).(8)The area under the ROC curve for the total score of the hyperthyroid microcirculation in the identification of CNS-NPSLE and intracranial infection was0.754.(9)The total score of conjunctival microcirculation in CNS-NPSLE group was significantly higher than that in the group of non-NPSLE and intracranial infection(P value was less than 0.001),and the total score of hyperthyroidism microcirculation in non-NPSLE group was significantly higher than that in intracranial infection group(P < 0.001).(10)The total score of the bulbar conjunctiva microcirculation was above 0.8 in the ROC curve for identifying intracranial infection group and CNS-NPSLE,intracranial infection and non-NPSLE.Conclusion:The levels of IL-6 and IL-8 in cerebrospinal fluid are good indicators for identifying patients in the CNS-NPSLE and non-NPSLE groups.The total score of hyperthyroidism microcirculation was generally used to identify the differential diagnosis between the intracranial infection group and the CNS-NPSLE group.Total conjunctival microcirculation score is a good indicator for identifying patients withCNS-NPSLE and intracranial infection.Therefore,cerebrospinal fluid cytokines(IL-6,IL-8)combined with microcirculation detection contribute to the differential diagnosis of CNS-NPSLE.