Study On Cerebrospinal Fluid Characteristics And NLRP3、CXCL10 Changes In Neuromyelitis Optica Spectrum Disease

ObjectiveThis study aims to retrospectively analyze the clinical data and cerebrospinal fluid(CSF)examination results of patients with neuromyelitis optica spectrum disease(NMOSD)in acute phase,to explore the CSF characteristics in patients with NMOSD.The expression levels of nucleotide binding oligomeric domain-like receptor protein 3(NLRP3)and CXC chemokine ligand 10(CXCL10)in serum and CSF of patients with NMOSD were detected,and their correlations with clinical indicators and CSF examination results were analyzed.Materials and methods55 patients diagnosed with NMOSD in the Department of Neurology,XX Hospital from June 2017 to December 2022 were selected as the objects.Clinical characteristics,laboratory examination,imaging examination,age,gender and other general demographic data of patients were collected for retrospective analysis,and clinical and CSF characteristics of NMOSD were summarized.A total of 21 patients with NMOSD in the acute phase from June 2017 to December 2022 were selected as the case group,and 22 patients with clinically diagnosed headache,dizziness,anxiety or lumbar disc herniation were selected as the control group.NLRP3 and CXCL10 levels in serum and CSF of NMOSD and control groups were detected by enzyme linked immunosorbent assay(ELISA),and the differences between groups were compared.The correlation between levels of the two factors and clinical and CSF outcomes was analyzed.Results1.Clinical characteristics of NMOSD patientsA total of 55 patients with serum AQP4-IgG positive NMOSD were included in this study,with a male to female ratio of 13:42 and an average age of 42.1±14.0 years(16-72 years).The common initial symptoms are acute myelitis and optic neuritis.The common clinical manifestations are dyskinesia,dysesthesia,impaired vision,visual field defect,bowel and bladder dysfunction,nausea and vomiting,and the vast majority of patients are effective for immunotherapy.2.Characteristics of cerebrospinal fluid in patients with NMOSD69.1%(38/55)of the NMOSD patients had an elevated CSF white blood cell count(>5/mm3),the median was 10/mm3,and 3 patients had a CSF white blood cell count over 50/mm3.The average level of CSF lactate in NMOSD was 2.43±0.66mmol/l,which was significantly higher than the normal value.The patients with NMOSD were divided into three subgroups according to the clinical manifestations and imaging results:simple myelitis,simple optic neuritis and simple brain lesions.The median CSF white blood cell count in patients with simple myelitis was 11/mm3,and that in patients with simple brain lesions was 4/mm3,and there was a statistical difference between the two groups(P=0.03).The presence of monocytes and lymphocytes was observed in all samples,while neutrophils were present in only one sample of myelitis.extended disability scale score(EDSS)was used to assess the disease severity of NMOSD patients,and CSF IgG and lactate levels were correlated with EDSS,suggesting that the CSF IgG and lactate levels may reflect the disease severity of patients potentially.3.Changes of NLRP3 and CXCL10 in NMOSDThe NLRP3 level was 0.96(0.48,2.07)ng/ml in the case group and 0.46(0.2 1,0.94)ng/ml in the control group.The NLRP3 level in the case group was higher than that in the control group(Z=-2.940,P=0.003).The level of serum CXCL10 in the case group was 18.59(17.82,20.94)pg/ml,and that in the control group was 23.83(20.77,27.16)pg/ml.The level of serum CXCL10 in the case group was significantly lower than that in the control group(Z=-2.155,P=0.031).The level of CSF CXCL10 was 76.10(23.67,143.79)pg/ml in the case group and 77.68(43.82,93.87)pg/ml in the control group,with no statistical significance between the two groups(Z=0.882,P=0.904).4.Correlation between clinical and cerebrospinal fluid characteristics and NLRP3 and CXCL10 levels in patients with NMOSDThere was no correlation between serum NLRP3 concentration and EDSS score,CSF white blood cell count,protein,IgG,IgM,IgA and lactate in case group.Serum CXCL10 concentration was correlated with CSF IgG(r=0.-0.536,P=0.018)and IgM(r=-0.476,P=0.040),but not with CSF white blood cell count,protein,IgA and lactate levels.CXCL10 concentration in CSF was correlated with CSF IgM(r=-0.584,P=0.022),but not with CSF white blood cell count,protein,IgG,IgA and lactate levels.Conclusion1.The levels of CSF white blood cell count and lactate in NMOSD were significantly increased.2.In NMOSD,the CSF white blood cell count in patients with simple myelitis was higher than that in patients with simple brain lesions.3.CSF IgG and lactate levels were correlated with EDSS in patients with NMOSD.4.In NMOSD patients with positive AQP4-IgG,the serum NLRP3 concentration increased and the serum CXCL10 concentration decreased in the acute stage.5.In NMOSD patients with positive AQP4-IgG,the concentrations of serum CXCL10 were correlated with CSF IgG and IgM,and the concentrations of CSF CXCL10 were correlated with CSF IgM.