| BackgroundAutoimmune glial fibrillary acidic protein astrocytopathy is a group of neurological syndromes that can involve the meninges,brain,spinal cord,and optic nerves.Because both GFAP-A and optic neuromyelitis belong to autoimmune astrocytopathy,and both can have visual abnormalities and long segment myelitis,it is necessary to differentiate.Clinical symptoms and CSF indicators of GFAP-A have no obvious specificity,and some patients may present with fever and headache,increased white blood cell count,increased protein and decreased sugar content in CSF,which is consistent with the characteristics of tuberculous meningitis and prone to misdiagnosis.Immune diseases and infectious diseases are treated in completely different directions and must be identified before treatment.However,there is currently A lack of clinical studies comparing GFAP-A with other diseases with similar manifestations at home and abroad.In this study,the clinical characteristics and laboratory tests of GFAP-A,neuromyelitis optica and tuberculous meningitis were compared and analyzed to provide evidence for differential diagnosis and later treatment.ObjectivesTo investigate the general data,clinical manifestations,cerebrospinal fluid(CSF)and magnetic resonance imaging(MRI)characteristics of GFAP-A patients,and to find the similarities and differences between the clinical characteristics of GFAP-A and tuberculous meningitis(TBM)and optic neuromyelitis(NMO),so as to provide references for the identification of the three.MethodsA retrospective analysis was performed on 145 patients admitted to the department of neurology(source:the second affiliated hospital of guangzhou medical university,the sanjiu brain hospital of guangdong,the third affiliated hospital of sun yat-sen university)from July 2015 to March 2020,including 62 patients with GFAP-A,43 patients with tuberculous meningitis and 40 patients with optic neuromyelitis.The general data,clinical manifestations,cerebrospinal fluid and whole blood results,visual evoked potential,craniocerebral and spinal magnetic resonance imaging and other indicators of the three groups of patients were compared and analyzed by statistical method,and the differential diagnosis value of each indicator on the three groups was analyzed by stepwise discriminant analysis,and the discriminant function was established.Results1.General information:the ratio of male to female in GFAP-A patients was 1:0.72,and the average age of the first onset was(44.50±16.08)years old.The ratio of male to female in TBM patients was 1:1.26,and the average age of the first onset was(43.14±18.01)years old.The ratio of male to female in NMO patients was 1:19,and the average age of the first onset was(42.55±13.15)years old.The proportion of women in the NMO group was higher(X~2=29.306,P=0.000).There was no statistically significant difference in age of onset between the three groups(F=0.203,P=0.817).2.The first clinical symptoms of the three groups were compared with each other,and the difference in the proportion of the following symptoms was statistically significant:(1)the proportion of headache,fever and disturbance of consciousness was the highest in the TBM group,followed by the GFAP-A group,and the lowest in the NMO group.The proportion of visual impairment was the highest in the NMO group,followed by the GFAP-A group,and the lowest in the TBM group.The differences among the three groups were statistically significant(P<0.05).(2)the proportion of abnormal mental behavior in both the GFAP-A group and the TBM group was higher than that in the NMO group,and the proportion of limb numbness and limb pain was lower than that in the NMO group,with statistically significant differences(P<0.05).There was no statistically significant difference between the GFAP-A group and the TBM group(P>0.05).(3)the proportion of limb weakness in both the GFAP-A group and the NM0 group was higher than that in the TBM group,and the proportion of nausea/vomiting was lower than that in the TBM group,with statistically significant differences(P<0.05).There was no statistically significant difference between the GFAP-A group and the NMO group(P>0.05).(4)the proportion of ataxia and urinary and stool disorders in the GFAP-A group was higher than that in the TBM group,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the NMO group and the GFAP-A group,and between the NMO group and the TBM group(P>0.05).3.CSF:compared with the data of the three groups,CSF pressure,white blood cell count,and protein content were in the order of(TBM>GFAP-A>NMO),and the differences were statistically significant(P<0.05).The ratio of CSF glucose,CSF chlorine and CSF/blood glucose was(NMO>GFAP-A>TBM),and the differences were statistically significant(P<0.05).CSF/blood chloride ratio<NMO group in TBM group,the difference was statistically significant(P<0.05).4.Visual evoked potential:32 VEP tests were performed in the GFAP-A group,and the overall abnormal rate of VEP was 53.13%(17/32).There were 2 routine VEP checks in TBM group,and the overall abnormal rate of VEP was 0.00%(0/2).There were 39 routine VEP examinations in the NMO group,and the overall abnormal rate of VEP was 87.88%(26/39).The overall abnormal rate of VEP in the three groups was compared,and the difference was not statistically significant(P>0.05).5.Magnetic resonance imaging:the positive rate of brain MRI in GFAP-A group was72.13%(44/61).The positive rate of brain MRI in TBM group was 75.00%(24/32).The positive rate of brain MRI in NMO group was 35.90%(14/39).Compared with the NMO group,the GFAP-A group and TBM group were higher than the NMO group(X~2=16.251,P<0.05).There was no statistically significant difference in the distribution ratio of craniocerebral MRI lesions between the three groups(P>0.05).There was no statistically significant difference between the three groups in the positive rate of brain MRI angiolike radial enhancement(P>0.05).The positive rates of spinal MRI in GFAP-A group,TBM group and NMO group were 50.00%(25/50),20.00%(1/5)and 97.50%(39/40).Compared with TBM group,NMO group and GFAP-A group had higher overall positive rate of spinal MRI(X~2=32.823,P<0.05),the difference was statistically significant.The distribution ratio of spinal MRI lesions in the three groups was compared,and the comparison of lesion segment length was not statistically significant(P>0.05).6.According to the discriminant function established by stepwise discriminant analysis,the accuracy of diagnosis of GFAP-A,TBM and NMO was 85.5%,92.4%and93.1%,the sensitivity was 82.3%,83.7%and 92.5%,and the specificity was 88.0%,96.1%and 93.3%,respectively.The discriminant function established in this study is good for the diagnosis of GFAP-A,TBM and NMO.Conclusion1.The female proportion of GFAP-A patients was lower than that of NMO.2.The proportion of headache,fever and disturbance of consciousness in GFAP-A patients was higher than that of NMO and lower than that of TBM;The proportion of visual impairment was higher than TBM and lower than NMO.The proportion of abnormal mental behavior was higher than that of NMO.The proportion of limb weakness,ataxia and urinalysis were all higher than TBM.The proportion of numbness and pain in limbs was lower than that of NMO.Nausea/vomiting ratio is lower than TBM.3.The values of CSF pressure,white blood cell count and protein content in GFAP-A patients were higher than NMO and lower than TBM.The ratio of CSF glucose,CSF chlorine and CSF/blood glucose was higher than TBM and lower than NMO.4.The positive rate of brain MRI in patients with GFAP-A was higher than that of NMO;The positive rate of spinal MRI was higher than that of TBM.5.The discriminant function established by stepwise discriminant analysis can improve the early diagnostic accuracy of GFAP-A,but the diagnosis still needs to be combined with clinical characteristics and immunological detection. |
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