Comparison of cerebrospinal fluid characteristics in three rare types of autoimmune inflammatory demyelinating diseases
YANG Yue
XUE Gao-jie
LIU Lu
WANG Yan-bai
HOU Yu-ting
YANG Xiao
Abstract：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.
Keywords：Demyelinating autoimmune diseasesCNSCerebrospinal fluidLeukocyte countProteins
Publication Date：2025-12-25
Online Publishing Date：2026-01-23(First online date of this platform, not the publication date of the document)
Pages：7( 1121-1127 )