The Expression And Significance Of GADA And GM1-A In Serum Of Children With Refractory Epilepsy

Objectives To research on the level of glutamic acid decarboxylase antibodyand anti ganglioside antibody in serum of children with refractory epilepsy,analyze the correlation between the immunological pathogenesis of refractory epilepsy and the two kinds of serum antibodies,and to provide a new scientific basis for clinical diagnosis and treatment of refractory epilepsy.Methods The study was divided into two groups,namely refractory epilepsy group(RE group)and drug controlled epilepsy group(CE group),each group of 45 cases.The objects of study in 300 children with epilepsy for inpatient and outpatient follow-up from November 2015 to November 2016 in Tangshan City maternal and Child Health Hospital of pediatric neurology.According to the inclusion and exclusion criteria,206 children with epilepsy were screened out,including 45 cases of refractory epilepsy and 161 cases of drug controlled epilepsy.45 children with refractoy epilepsy were treated as a case group(RE group),and 45 children with drug controlled epilepsy were randomly selected as control group(CE group)to study and analyze.The definitions of epilepsy and epilepsy syndrome and the classification criteria of epileptic seizures are in accordance with the standards established by the International League Epilepsy(ILAE)for RE group and CE group.At the same time,it is consistent with the definition of domestic refractory epilepsy in children.The general conditions,clinical seizure types,seizure frequency and laboratory test results were recorded.The fasting blood of all children of the two groups were collected every morning.The serum glutamic acid decarboxylase antibody of(GADA)and anti ganglioside antibodies(GM1-A)were determined with a standard enzyme-linked immunosorbent assay(enzyme linked immunosorbent assay,ELISA).Statistical calculations were performed with SPSS17.0 software.Test of normality was performed among all the variables.The measurement data are expressed as mean± standard deviation((?)±s).The two groups were compared using independent sample t test.Count data expressed as percentage(%).Rate of sample of two groups were compared using by chi-square test.The nonparametric rank sum test is used for the measurement data which do not conform to the normal distribution.The diagnostic performance of GADA and GM1-A in children with RE are evaluated by the receiver operating characteristic(ROC)curve of the two antibodies.Draw the ROC curve and calculate the area under the ROC curve.A p value less than 0.05 was considered statistically significant(α=0.05).Results 1 The two antibodies of GADA and GM1-A both expressed in RE group and CE group,and the expression levels of these in the RE group were significantly higher than those in the CE group,the difference was statistically significant.2 The expression levels of GADA and GM1-A were correlated with the occurrence of refractory epilepsy in children.When the expression level of GADA was higher than the median concentration of 0.96mmol/L,the risk of intractable epilepsy was 16.1883.When the expression level of GM1-A was higher than the median concentration of 4.84ng/ml,the risk of intractable epilepsy was 5.451.The area under curve of GADA and GM1-A are respectively 0.847 and 0.759.The 95% confidence interval(CI)of GADA is 0.767-0.928.The 95% confidence interval(CI)of GM1-A is 0.660-0.857.The confidence intervals of the two antibodies are all greater than 0.5.The results showed that two kinds of antibodies have certain diagnostic value in children with RE.4 The GADA and GM1-A were analyzed by ROC curve,and the optimal concentration was respectively 4.36ng/ml and 0.96mmol/L.The sensitivity and specificity of the two antibodies in the diagnosis of RE were also achieved at the same time as the maximum concentration values.The ROC curve of two kinds of antibody was drawn,and the AUCROC value was 0.878.And the AUCROC was greater than GADA and GM1-A.The results showed that the combined two antibodies were more valuable than RE in the diagnosis of single antibody.Conclusions 1 RE is associated with autoimmune disorder in children,and GADA and GM1-A antibodies can be detected in serum.2 GADA and GM1-A were associated with the occurrence of RE,and increased risk of RE when the expression of the two antibodies was greater than the median concentration.3 Combined detection of serum GADA and GM1-A levels has the guiding role in the diagnosis,treatment and prognosis of RE in children.