外周血CD4<sup>+</sup>T细胞亚群、NK细胞比例、补体C3及IgG联合检测对儿童自身免疫性脑炎的诊断价值-现代医学

外周血CD4⁺T细胞亚群、NK细胞比例、补体C3及IgG联合检测对儿童自身免疫性脑炎的诊断价值

单位：内蒙古医科大学附属医院儿童重症监护室, 内蒙古呼和浩特 010030

分类号：R725

出版年·卷·期（页码）：2019·47·第七期（827-830）

摘要：

目的：分析自身免疫性脑炎患儿细胞免疫、体液免疫、补体系统的变化及其临床意义。方法：选取我院临床确诊为自身免疫性脑炎的30例患儿为病例组，同期健康体检儿童30例为对照组。分别检测两组外周血中CD3⁺、CD4⁺、CD8⁺等T细胞亚群数量，自然杀伤（NK细胞）比例，IgA、IgG、IgM等体液免疫因子及补体C3、C4的水平，并进行比较。结果：两组比较CD3⁺、CD8⁺T细胞亚群数量及补体C4、IgA、IgM的水平差异均无统计学意义（P>0.05），而病例组外周血CD4⁺T细胞亚群数量及NK细胞比例降低，补体C3及IgG水平均显著增高，且上述4项指标的变化在抗N-甲基-D-天门冬氨酸受体脑炎中最为显著。外周血CD4⁺T细胞亚群、IgG、补体C3及NK细胞比例区分自身免疫性脑炎儿童与健康儿童的受试者工作特征曲线下面积（AUC）分别为0.932（95%CI 0.879~0.985，P<0.001）、0.901（95%CI 0.840~0.963，P<0.001）、0.786（95%CI0.702~0.871，P<0.001）和0.684（95%CI0.592~0.776，P<0.001）;对应的敏感度和特异度分别为90.9%、90.1%，76.1%、88.5%，88.7%、76.1%和71.8%、59.2%；对应的临界值分别为458个·μl^-1、16.24 g·L^-1、1.75 g·L^-1和11.46%。外周血CD4⁺T细胞亚群、NK细胞比例、补体C3及IgG指标联合检测时，区分自身免疫性脑炎儿童与健康儿童的AUC为0.952（95%CI0.904~0.999，P<0.001）;在“并联”时的敏感度和特异度分别为94.6%和86.4%；在“串联”时的敏感度为69.7%，特异度为98.6%。结论：外周血CD4⁺T细胞亚群、NK细胞比例、补体C3及IgG水平有望为儿童自身免疫性脑炎的诊疗提供新的途径与思路。

Objective:To analyze the changes and its clinical significance of cellular immunity, humoral immunity, complement system in children with autoimmune encephalitis. Methods:Thirty children with clinically diagnosed autoimmune encephalitis in our hospital were selected as the case group, and 30 healthy children in the same period as the control group. The number of T lymphocyte subsets such as CD3⁺, CD4⁺, CD8⁺, the proportion of NK cells, the humoral immune factors such as IgA, IgG, IgM and the levels of complement C3 and C4 in peripheral blood of the two groups were measured respectively and were compared. Results:There was no significant difference in the number of CD3⁺, CD8⁺ T cell subsets and the levels of complement C4, IgA and IgM between the two groups(P>0.05). However, the number of CD4⁺ T cell subsets and the proportion of NK cells were decreased, and the levels of complement C3 and IgG were increased significantly in the case group, and the changes of the above 4 indicators were the most remarkable in anti-N-methyl-D-aspartate receptorencephalitis. The area under receiver operating characteristic curve(AUC) of the peripheral blood CD4⁺ T cell subset, IgG, complement C3 and NK cells ratio in distinguishing children with autoimmune encephalitis and healthy children were 0.932(95%CI0.879-0.985, P<0.001), 0.901(95%CI0.840-0.963, P<0.001), 0.786(95%CI0.702-0.871, P<0.001) and 0.684(95%CI0.592-0.776, P<0.001),respectively. The sensitivity and specificity of each index were 90.9% and 90.1%, 76.1% and 88.5%, 88.7% and 76.1%, and 71.8% and 59.2%, and the corresponding critical values were 458 μl^-1,16.24 g·L^-1,1.75 g·L^-1 and 11.46%. Whenperipheral blood CD4⁺ T cell subsets, NK cells ratio, complement C3, and IgG were combined, the AUC in distinguishing children with autoimmune encephalitis and healthy children was 0.952(95%CI0.904-0.999, P<0.001). In parallel, the sensitivity and specificity were 94.6% and 86.4%, respectively. In series, the sensitivity and specificity were 69.7% and 98.6%, respectively. Conclusion:Peripheral blood CD4⁺ T cell subsets, NK cells ratio, complement C3 and IgG levels are expected to provide new ways and ideas for the diagnosis and treatment of children with autoimmune encephalitis.

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