YANG Yue, XUE Gao-jie, LIU Lu, WANG Yan-bai, HOU Yu-ting, YANG Xiao
Objective To explore the cerebrospinal fluid (CSF) results of anti-aquaporin-4 (AQP4) IgG positive neuromyelitis optica spectrum disorders (NMOSDs), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) and compare their similarities and differences to provide a reference for its diagnosis and differential diagnosis. Methods and Results From April 2019 to August 2023, 38 patients with serum AQP4 -IgG-positive for NMOSDs, 14 patients with MOGAD and 27 patients with GFAP-A who were hospitalised in General Hospital of Ningxia Medical University were selected. The clinical data and CSF pressure, cytology, biochemistry and IgG of the 3 groups were collected after admission. Compared with the NMOSDs group, the MOGAD group and the GFAP -A group, the CSF pressure (F = 10.530, P = 0.000), white blood cell (WBC) count (χ2 = 11.892, P = 0.003), proportion of patients with WBC count ≥ 50 × 106/L (χ2 = 22.503, P = 0.000), proportion of eosinophils (χ2 = 13.551, P = 0.001), protein quatification (χ2 = 20.391, P = 0.000), glucose level (χ2 = 8.653, P = 0.013), proportion of patients with glucose < 2.20 mmol/L (Fisher′s exact probability: P = 0.010), and IgG (χ2 = 13.899, P = 0.001) were statistically significant. Further pairwise comparisons revealed that, compared with the NMOSDs group and the MOGAD group, the GFAP-A group had a higher CSF pressure (t = -80.012, P = 0.000; t = -61.222, P = 0.002), a higher WBC count (Z = -3.178, P = 0.001; Z = -2.618, P = 0.009), a higher proportion of cases with WBC count ≥ 50 × 106/L (Z = -4.163, P = 0.000; Z = -3.173, P = 0.002), higher level of protein quantification (Z = -4.193, P = 0.000; Z = -3.373, P = 0.001) and IgG (Z = -2.925, P = 0.003; Z = -3.375, P = 0.001), and a lower glucose level (Z = 2.433, P = 0.015; Z = 2.561, P = 0.010). Compared with the NMOSDs group, the GFAP-A group had a higher proportion of cases with eosinophils (Z = 3.643, P = 0.000) and a lower proportion of glucose < 2.20 mmol/L (Z = 2.795, P = 0.005). Conclusions The CSF of NMOSDs and MOGAD patients is similar in terms of pressure, cytology and biochemistry. Compared with NMOSDs and MOGAD, the CSF pressure and WBC count of GFAP-A patients are higher, eosinophil infiltration is more common, protein quatification and IgG levels are significantly increased, and glucose levels are generally reduced. These features may aid in the diagnosis and differential diagnosis of GFAP-A.
