吉兰-巴雷综合征脑脊液胱氨酸蛋白酶抑制剂C及常规指标检测的临床价值

目的探讨脑脊液胱氨酸蛋白酶抑制剂C（Cystatin C）及常规指标检测在吉兰-巴雷综合征（GBS）中的临床应用价值。方法 （1）对比分析脑脊液Cystatin C及脑脊液葡萄糖（Glu）、脑脊液氯化物（Cl）、脑脊液总蛋白（TP）、脑脊液微量白蛋白（mALB）、白蛋白熵（QALB）、脑脊液白细胞计数（WBC）及计算指标白细胞计数与脑脊液总蛋白比值（WBC/TP）和白细胞总数与脑脊液微量白蛋白比值（WBC/mALB）]在GBS（n=20）及结核性脑膜炎（TBM）（n=54）、脑膜脑炎（MC）（n=24）、脑炎（Enc）（n=37）及正常对照组（NCG）（n=22）中的表达特征,并分别比较GBS和NCG组与其他观测组前述指标之间的差异;（2）将所有观测组按Cystatin C水平四分位分组,分析各疾病组Cystatin C分布水平;（3）将GBS组按急慢性及轻重程度分组,并分别观测其各组Cystatin C水平差异。结果 （1）157例受检者脑脊液前述指标检测结果显示：TBM及MC中Glu、Cl均值显著低于NCG（P〈0.05）,GBS及Enc该指标与NCG无显著差异（P〉0.05）;TBM及MC中TP分别高达（1615.4±992.8）mg/L和（1484.9±1746.5）mg/L,显著高于NCG组（P〈0.05）,Enc及GBS中TP亦升高,分别为（427.9±245.5）mg/L,（1001.5±1364.9）mg/L,但与NCG比较无显著差异（P〉0.05）,GBS和TBM中TP分布离散,该两组间差异显著（P〈0.05）;MC、TBM、GBS中mALB分别为（731.4±653.9）mg/L、（773±521.3）mg/L、（484.9±667.9）mg/L,较NCG差异显著（P〈0.05）,而Enc组mALB为（276.1±171.6）mg/L,与NCG无显著差异（P〉0.05）;在MC、TBM、Enc中QALB均显著高于NCG（P〈0.05）,而GBS与NCG差异不显著（P〉0.05）,但GBS与TBM相比有显著差异（P〈0.05）;MC、TBM、Enc中WBC分别为（81.3±117）×106/L,（726.4±862.8）×106/L和（18.8±29.7）×106/L,均显著高于NCG（P〈0.05）,而GBS为（13.6±18.3）×106/L,各组中WBC分布均较离散;在TBM中WBC可高达数千,MC中达数百,Enc中超过100余,而GBS中低于100;各观察组WBC/TP与正常对照均有显著差异（P〈0.05）,且GBS与TBM组间也有差异（P〈0.05）;各观察组WBC/mALB均高于正常对照（P〈0.05）,均较离散;除TBM中Cystatin C（4.87±1.26）mg/L]较NCG（5.4±1.15）mg/L]差异不显著外,MC、Enc、GBS均显著低于正常（P〈0.05）,分别为（3.37±1.28）mg/L,（3.15±0.93）mg/L,（3.74±0.97）mg/L,另MC及Enc均与GBS组无显著差异（P〉0.05）。（2）各组脑脊液Cystatin C分布分析显示：高达60%以上的GBS、Enc及MC患者脑脊液Cystatin C处于较低水平（≤4.11 mg/L）,其中≤3.08 mg/L者亦接近40%左右,而TBM及NCG组〉4.11 mg/L占极大部分,≤3.08 mg/L者TBM中仅接近5%,NCG中则无,卡方检验显示疾病分组与Cystatin C分布区间有一定关系（P〈0.05）。（3）急性GBS重症、轻症及慢性患者中脑脊液中Cystatin C分别为（3.91±1.28）mg/L,（3.70±0.92）mg/L和（3.36±0.75）mg/L,轻重症之间、急慢性之间均无显著差异（P〉0.05）。结论脑脊液Cystatin C及其他常规标志物在GBS、MC、TBM及Enc中的表达各有特征,脑脊液Cystatin C作为GBS诊治过程中的重要标志物值得期待,联合其他标志物可为临床提供诊断及鉴别信息。

Clinical value of Cystatin C and common biomarkers in cerebrospinal fluid for Gnillain-Barre syndrome

Objective This investigation describes the discovery of the clinical value of Cystatin C and common biomarkers in cerebrospinal fluid for Guillain-Barre Syndrome. Methods （1）20 Guillain-Barre Syndrome, 54 tubercular meningitis, 24 meningocephalitis, 37 encephalitis and 22 normal control were included in the study. CSF was collected and analyzed for Cystatin C, glucose, chloride, total protein（TP）, microalbumin（mALB）, QALB, white blood cell count（WBC）, and calculated WBC/TP and WBC/mALB. The expression features of the mentioned biomarkers were observed in above-mentioned groups; （2）All cases were divided into groups by quartiles of the levels of Cystatin C in CSF, and the relationship of the distributions of Cystatin C with the disease groups were tested; （3）The cases of GBS were be divided into groups by acute or chronic and the degree of the severity of illness, and the difference between each groups were be observed. Results 157 cases of examined results showed that glucose and chloride in patients with MC,TBM were obvious lower than NCG（P〈0.05）, but Glu and C1 with GBS and Enc were no remarkable difference than NCG（P〉0.05）; rised total protein of TBM and MC were （1615.4±992.8）mg/L and （1484.9±1746.5）mg/L respectively, and striking difference than NCG（P〈0.05）; but total protein of Enc and GBS were （427.9±245.5）mg/L and （1001.5± 1364.9）mg/L separately, their rises were small in degree, and without outstanding difference than NCG（P〉0.05）, total protein of GBS was scattered in distribution, and marked difference than men（P〈 0.05）; microalbumin of MC, TBM and GBS were （731.4±653.9）mg/L, （773 ± 521.3）mg/L, （484.9± 667.9）mg/L respectively, and pronounced increased than NCG（P〈0.05）, only Enc without striking difference than NCG（P〉0.05）; quotient of albumin in CSF（QALB） in MC, TBM and Enc were all higher than NCG（P〈0.05）, but GBS had no remarkable difference with NCG（P〉0.05）; it had striking difference than TBM（P〈0.05）; white blood cell counts of CSF in MC,TBM and Enc were （81.3±117）× 10r/L, （726.4±862.8）× 106/L, （18.8±29.7）×106/L respectively, and pronounced higher than NCG（P〈 0.05）, but WBC of GB S were （13.6±18.3） × 106/L; WBC in TBM reached thousands, in MC may reached hundreds, in Enc was more than one hundred, but in GBS it was less than 100; WBC/TP of 4 observation diseases groups had outstanding difference than NCG（P〈0.05）, there was marked difference as well about WBC/TP between GBS and TBM（P〈0.05）, but WBC/TP were all more scattered distribution except TBM, mean value of each group had divergence of level, TBM was 5.25 times than MC, and 7.64 times than Enc, 12.76 times than GBS; WBC/mALB of each observation group were higher than NCG（P〈0.05）, and the scattered distributions were observed in all groups.The levels of Cystatin C of MC, Enc, GBS and TBM were（3.37 ±1.28）mg/L, （3.15 ± 0.93）mg/L, （3.74± 0.97）mg/L and （4.87 ±1.26）mg/L respectively, and lower than NCG （5.4±1.15）mg/L （P〈0.05） except TBM, and MC and Enc had no outstanding difference than GBS（P〉 0.05）;the interval of Cystatin C＇s levels related to different diseases of groups; Cystatin C in acute serious or mild, chronic of patients with GBS were（3.91 ±1.28）mg/L, （3.70 ± 0.92）rng/L and（3.36±0.75）mg/L respectively, outstanding difference among groups could not be observed（P〉0.05）. Conclusion The expression on Cystatin C of CSF in GBS, MC, TBM and Enc have individual characteristics, and should be distinguished be each other in condition to combined with other common biomarker; and Cystatin C should be a valuable biomarker to provide valuable informations to diagnose and discriminate GBS.