CSFB -: lymphocyte chemoattractant (CXCL13) in the early diagnosis of acute Lyme neuroborreliosis
CSFB -: lymphocyte chemoattractant (CXCL13) in the early diagnosis of acute Lyme neuroborreliosis
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DOI：
10.1007/s00415-008-0785-y
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发表时间：
2008-05-01
影响因子：
6
通讯作者：
Mygland, Ase
中科院分区：
文献类型：
--
作者：
Ljostad, Unn;Mygland, Ase
最近的研究表明，B淋巴细胞趋化因子（CXCL 13）在脑脊液（CSF）中的莱姆病神经疏螺旋体病（LNB）的诊断作用。我们的目的是评价CSF CXCL 13在59例因疑似LNB而转诊至医院的连续患者队列中的诊断准确性。37例患者被归类为明确的LNB，并作为参考标准。7人被列为可能，7人被列为可能的LNB。8例不符合病例定义的患者作为对照组，与CSF B阳性患者相比，所有确诊LNB患者的CSF CXCL 13均升高。37例中33例检测出抗Bb抗体指数（AI）。CSF CXCL 13升高和CSF Bb AI阳性的治疗前敏感性分别为100%（95%CI = 91-100）和78%（95%CI = 75-96）（p = 0.053）。在8名对照患者中，5名CSF CXCL 13正常，3名仅轻微升高，5名Bb AI阴性。CSF CXCL 13和Bb AI的特异性相似，为63%（95% CI = 31-86）（p = 1.0）。在6/7例可能LNB患者和3/7例可能LNB患者中CSF CXCL 13升高。对照组包括31例多发性硬化（MS）、11例非炎性神经系统疾病和10例经证实的非莱姆病脑膜炎和高CSF细胞计数。CSF CXCL 13在15名MS患者和9名脑膜炎患者中略有升高。明确LNB患者的平均CSFCXCL 13（3524 ng/gCSF蛋白）高于MS（27 ng/g）和非莱姆病脑膜炎（23 ng/g）（P < 0.001）。治疗后4个月，82%的明确LNB患者CSFCXCL 13恢复正常，而BbAI阴性患者仅为10%（P <0.001）。
Recent studies have suggested a diagnostic role of the B-lymphocyte attracting chemokine (CXCL 13) in the cerebrospinal fluid (CSF) in Lyme neuroborreliosis (LNB). Our aim was to evaluate diagnostic accuracy of CSF CXCL13 in a cohort of 59 consecutive patients referred to hospital for suspected LNB. Thirty-seven patients were classified as definite LNB and used as the reference standard. Seven were classified as probable, and seven as possible LNB. Eight patients did not fulfil case definitions and were used as controls.At presentation, CSF CXCL13 was elevated in all patients with definite LNB, as compared to a positive CSF B. burgdorferi (Bb) antibody index (AI) in 33 of 37. Pre-treatment sensitivity of elevated CSF CXCL13 and positive CSF Bb AI was 100% (95% CI = 91-100) and 78% (95% Ci = 75-96) respectively (p = 0.053).Among the eight control patients, CSF CXCL 13 was normal in five and only slightly elevated in three, and Bb AI was negative in five. Specificity of CSF CXCL13 and Bb AI was similar 63% (95% CI = 31-86) (p = 1.0). CSF CXCL13 was elevated in 6/7 patients with probable LNB and 3/7 patients with possible LNB. Bb AI was negative in all these 14 patients.An additional control group consisted of 31 patients with multiple sclerosis (MS), 11 with non-inflammatory neurological diseases, and ten with verified non-Lyme meningitis and high CSF cell count. CSF CXCL13 was slightly elevated in 15 MS patients, and in nine meningitis patients. Mean CSF CXCL13 was higher in definite LNB (3524 ng/g CSF protein) than in MS (27 ng/g) and non-Lyme meningitis (23 ng/g) (P < 0.001).Four months post-treatment CSF CXCL13 was normalized in 82% of patients with definite LNB, as compared to a negative Bb AI in 10% (p