Correlation Of The Level And Change Of CXCL13in Serum And Cerebrospinal Fluid And Clinical Isolated Syndrome,multiple Sclerosis And Neuromyelitis Optica

Background:Clinical isolated syndrome(CIS), it is to point that acute or subacute single attack in the central nervous system except the other diseases, and last time more than24hours, the develop of the time and the progress of the space are not accord with multiple sclerosis(MS) or neuromyelitis optica(NMO) diagnostic criteria. CIS mainly includes optic neuritis(ON), isolated brainstem injury or spinal cord injury syndrome. There are many kinds of final outcome of CIS, including MS, NMO, transversemyelitis(TM), acuted disseminated encephalo-myelitis(ADEM)and so on. Reports in document,30%～70%of CIS patients eventually developed to multiple sclerosis, and85%of MS patients performed CIS firstly. In recent years, there has been a hot spot research on the CXCL13involved in the immunoreaction, Johannes Brettschneider finded that the CXCL13in active inflammatory damage period of MS patients, which showed the CXCL13can as MS relapse marker. The high level of CXCL13in CIS patients convert to different MS subtypes, which showed the marker of CXCL13can predicts the outcome of CIS. Therefore, the high level of CXCL13in cerebrospinal fluid(CSF) can predict CIS patients convert to MS earlier, and these will provide the scientific basis for further study of the pathological characteristics, the pathogenesis, the outcome and treatment, with important clinical significance.Objective:To investigate the correlation between B lymphocyte chemoattractant-1(BLC-1/CXCL13) level in serum and CSF and disease progress, extended disability status scale (EDSS)score, the number of white blood cells(WBC) in CSF, evoked potential examination and MRI in patients with CIS, relapsing-remitting multiple sclerosis (RRMS), and NMO.Methods:Choosing18cases of CIS,22cases of RRMS,21cases of NMO, and17cases of neurological non-inflammatory disease (NND)(as a control group), in the disease period, all four groups patients were performed EDSS score, MRI examination, evoked potential examination, respectively.By ELISA test method, detected and compared the CXCL13level in serum and CSF in four group patients; The CXCL13level in the serum and CSF was compared between EDSS≥3.5points group and EDSS<3.5points group, and between the groups with positive and negative in MRI enhancement in brain and spinal cord, and between the CSF of the WBC>10×106/L group and the WBC<10×106/L group, and also between the aberrant group and normal group in evoked potential examination;18CIS cases were separated into2groups, the CXCL13level>10pg/ml group and the CXCL13level<10pg/ml group, and were followed for two years, comparing the number of CIS patients conversion to MS in these two groups.Results:Compared with NND group, the CXCL13level in serum and CSF was higher in CIS group, RRMS group, and NMO group (P<0.01), especially the CXCL13level in CSF of RRMS group patients was higher than that in CIS group and NMO group(P<0.01); The CXCL13level in the serum and CSF was higher in the EDSS≥3.5points group patients than the EDSS<3.5points group patients(P<0.01); In addition,48patients were conducted the MRI enhanced scanning of brain and spinal cord, the result showed that the CXCL13level in CSF of enhanced lesions patients was higher than those patients with no enhanced lesions(P<0.01). The level of CXCL13is higher in WBC>10×106/L of CSF group patients than WBC <10×106/L of CSF group patients; There were no significant difference of the CXCL131evel in serum and CSF between aberrant and normal evoked potential examination group (P>0.05); There is the higher conversion rate (conversion to MS in two years) in the CXCL13level>15pg/ml patients than the CXCL13level<10pg/ml patients (P>0.05)Conclusion:The CIS patients with high level of CXCL13in CSF may earlier convert to MS, the CXCL13may be a marker and predicting MS conversion; The high level of CXCL13in serum and CSF indicates the RRMS patients relapse; The higher level of CXCL13in serum and CSF is related to the NMO patients acute inflammation, with no clinical specificity; The high level of CXCL13in CSF patients have MRI enhanced lesion in brain or spinal cord, which may make the immunocytes activated, myelin sheath lost and nerve function disordered.