| Objective:Autoimmune encephalitis is a group of diseases mediated by autoimmune mechanisms,resulting from neurological dysfunction caused by inflammatory lesions of the brain parenchyma.When combined with a tumor,it is also described as paraneoplastic autoimmune encephalitis.Chinese expert consensus on the diagnosis and management of autoimmune encephalitis(2022 edition)(Consensus for short)classifies AE into three main types: anti-N-methyl-D-aspartate-receptor(NMDAR)encephalitis,limbic encephalitis,and other autoimmune encephalitis syndromes.In this study,autoimmune encephalitis was classified autoimmune encephalitis against intraneuronal antigens(AEAIA)and autoimmune encephalitis against neuronal surface antigens(AEASA)depending on the differences in antigenic location and pathogenic mechanism.The similarity of clinical manifestations,ancillary tests,and cerebrospinal fluid biochemistry indictors between the two types of autoimmune encephalitis has caused troubles to clinicians and affected the development of treatment protocols.Therefore,in this study,we collected and compared the clinical information of the two types of encephalitis in our hospital to help improve the understanding of these two types of autoimmune encephalitis and to explore the feasibility of cerebrospinal fluid indicators as differential diagnostic markers,so as to provide new approaches and ideas for the early differentiation of these two types of encephalitis.Methods:1.The 2022 Consensus was utilized as diagnostic criteria to recruit individuals diagnosed with autoimmune encephalitis from January 2018 to December 2022 in Jilin University First Hospital.A series of 146 patients in the AEAIA group(n=38)and AEASA group(n=108)were enrolled.Data such as gender,age of onset,duration of hospitalization and days of intensive care unit(ICU)admission,whether tracheal intubation was performed,modified Rankin Scale(m RS)scores at admission and discharge after immunotherapy,clinical manifestations were collected,and test results such as routine blood,biochemistry,uric acid,homocysteine,fasting glucose,cerebrospinal fluid assay,and head magnetic resonance imaging(MRI)and electroencephalogram were also obtained for analysis and comparison.A score of m RS ≤ 2 is defined as good function,and a score of m RS > 2 is defined as poor function.2.To explore the performance of individual and combined indicators of cerebrospinal fluid pressure,protein,white blood cell count,chloride and glucose content in the differential diagnosis of AEAIA and AEASA by using receiver operating characteristic curve(ROC).3.SPSS 26.0 software was utilized to analyze and compare the difference between the two groups,and Origin 2022 was used to visualize the data.A significant P value below 0.05 was considered significant statistically.Results:1.Analysis of the clinical characteristics of the AEAIA and AEASA groups1)The incidence of encephalitis with Hu and anti-glutamic acid decarboxylase 65(GAD65)was highest in the AEAIA group.While in the AEASA group,the highest incidence of anti-leucine-rich glioma inactivated protein 1(LGI1),anti-NMDAR and anti-γ-aminobutyric acid-B receptor(GABABR)encephalitis.2)Age at onset,protein content,protein/leukocyte ratio,protein/ glucose ratio,protein/chlorine ratio,and immunoglobulin Ig G in cerebrospinal fluid were greater in the AEAIA group than in the AEASA group,but the proportion of m RS≤2 at discharge after immunotherapy,blood lymphocyte count and cerebrospinal fluid chloride content were lower than in the AEASA group,with statistically significant differences(P<0.05).3)The proportion of dizziness,limb weakness,weight change,involuntary movements,combined tumors and unsteady walking was greater in the AEAIA group than in the AEASA group,but the proportion of seizures was inferior than in the AEASA group,and the difference was statistically significant(P<0.05).4)Proportion of multiple hospitalizations,days in hospital,gender,fever,headache,memory disturbance,sleep disturbance,abnormal psychiatric behavior,hallucinations,cerebrospinal fluid pressure,cerebrospinal fluid white blood cell count and glucose,serum white cell and neutrophil count,C-reactive protein,procalcitonin,urea nitrogen,blood creatinine,D-dimer,liver function,uric acid,cholesterol,triglycerides,LDL cholesterol,HDL cholesterol,homocysteine,fasting glucose,glycosylated hemoglobin,folic acid,thyroid function,tumor markers,erythrocyte sedimentation rate,electroencephalogram and head MRI abnormalities were not statistically different(P>0.05).2.Analysis of the efficacy of cerebrospinal fluid indicators in the differential diagnosis of AEAIA and AEASA1)The cerebrospinal fluid protein/glucose ratio and cerebrospinal fluid protein/chlorine ratio AUC values were the largest when a single indicator was used for the differential diagnosis of the two groups.When applying the cerebrospinal fluid protein/glucose ratio the AUC value was 0.76(95% CI 0.68-0.83),P<0.05,with a sensitivity of 72.93% and specificity of 70.40%,and when applying the cerebrospinal fluid protein/chlorine ratio for differential diagnosis,the AUC value was 0.76(95% CI 0.69-0.84),P<0.05,with a sensitivity of 82.09% and specificity of 57.41%.2)When using the conjoint indicator for the differential diagnosis of the two groups,the maximum AUC value was observed with the cerebrospinal fluid leukocyte combined with protein/chlorine ratio and the cerebrospinal fluid chloride combined protein/glucose ratio.The AUC value was 0.76(95% CI 0.68-0.84),P<0.05,sensitivity was 84.33% and specificity was 56.60% for the combined protein/chlorine ratio with cerebrospinal fluid leukocytes.When cerebrospinal fluid chloride was combined with protein/glucose ratio,the AUC value was 0.76(95% CI 0.68-0.83),P<0.05,the sensitivity was 71.97% and the specificity was 71.37%.In contrast to the single indicator,the conjoint indicator did not increase the AUC value.Conclusion:1.The proportions of clinical manifestations such as age at onset,dizziness,limb weakness,weight change,involuntary movements,unsteady walking,presence of tumors and poor prognosis at discharge with immunotherapy were higher in the AEAIA group than in the AEAIA group.And the proportion of seizures,blood lymphocyte count was lower than the AEASA group.2.Cerebrospinal fluid protein and immunoglobulin Ig G content,protein/leukocyte ratio,protein/ glucose ratio,and protein/chlorine ratio were higher in the AEAIA group than in the AEASA group,and cerebrospinal fluid chloride content was lower than in the AEASA group.3.Cerebrospinal fluid protein/glucose ratio,protein/chlorine ratio,cerebrospinal fluid leukocyte combined protein/chlorine ratio,and cerebrospinal fluid chloride combined protein/glucose ratio were more effective in the differential diagnosis of AEAIA and AEASA. |
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