腦脊髓液的白蛋白和總蛋白可作為區分神經精神全身性紅斑狼瘡和中樞神經系統惡性腫瘤之指標

The Cerebrospinal Fluid (CSF) Albumin and Total Protein Serves as a Biochemical Marker to Help Differentiate between Neuropsychiatric Systemic Lupus Erythematosus and Central Nervous System Malignancies

目的：評估腦脊髓液的參數是否可以有效區分神經精神全身性紅斑狼瘡和中樞神經系統惡性腫瘤。
方法：本研究是回溯性觀察型研究，於台大醫院進行，收錄自2014年1月至2019年12月診斷為神經精神全身性紅斑狼瘡或中樞神經系統惡性腫瘤，且接受過腦脊髓液檢查的病人。透過病歷回顧的方式分析病人的基本資料、臨床特徵及腦脊髓液參數，進行後續分析。
結果：本研究共納入了50名患有神經精神全身性紅斑狼瘡或中樞神經系統惡性腫瘤的患者。神經精神全身性紅斑狼瘡患者佔病例的38%，實體癌和血液惡性腫瘤則分別佔36%和26%。肺癌是最常見的實體癌，原發性中樞神經系統淋巴瘤是最常見的血液系統惡性腫瘤。在神經精神全身性紅斑狼瘡患者中，癲癇是最常見的症狀。而實體瘤和血液惡性腫瘤最常見的症狀則是無菌性腦膜炎和頭痛。腦脊髓液數據部分，神經精神全身性紅斑狼瘡比起中樞神經系統惡性腫瘤，腦脊髓液中的細胞增多較少見。此外，與神經精神全身性紅斑狼瘡組相比，中樞神經系統惡性腫瘤組的腦脊液白蛋白和總蛋白顯著較高。免疫球蛋白G和免疫球蛋白G指數（IgG index）則無顯著差異。
結論：我們的研究結果表明，腦脊髓液參數包括細胞增多、白蛋白和總蛋白，可能是有助於區分神經精神全身性紅斑狼瘡或中樞神經系統惡性腫瘤之指標。

Objectives: The aim of our study is to investigate whether CSF parameters can effectively distinguish between neuropsychiatric systemic lupus erythematosus (NPSLE) and central nervous system (CNS) malignancies.
Methods: This retrospective observational study was conducted at National Taiwan University Hospital (NTUH) from January 2014 to December 2019. The study included patients who were clinically diagnosed with NPSLE or CNS malignancies. Data for the study was extracted from the NTUH electronic medical record (EMR) database, including patients' clinical presentation and CSF data.
Results: The study included 50 patients with NPSLE or CNS malignancies. The NPSLE patients accounted for 38% of cases, while solid cancers and hematologic malignancies accounted for 36% and 26% respectively. Lung cancers were the most common solid cancers, and primary CNS lymphoma were the most common hematologic malignancies. Among the NPSLE patients, seizure disorders were the most common symptoms reported. Aseptic meningitis and headache were common symptoms in both solid and hematologic malignancies. Pleocytosis of CSF was less common in NPSLE compared to CNS malignancies. Additionally, CSF albumin and total protein levels were higher in malignancies groups compared to the NPSLE group. There were no significant differences in CSF IgG levels and IgG index among the groups.
Conclusion: Our findings indicate that CSF parameters, including pleocytosis, albumin, and total protein, might be helpful in differentiating NPSLE from CNS malignancies.