Clinical value of cerebrospinal fluid and serum immunoglobulins in the differential diagnosis of anti-NMDAR encephalitis and anti-LGI1 antibody-associated encephalitis

doi:10.3969/j.issn.1004-583X.2026.08.007

Abstract

Abstract:

Objective To analyze the characteristics of cerebrospinal fluid (CSF) and serum immunoglobulins in patients with anti-N-methyl-D-aspartic acid receptor (NMDAR) encephalitis and anti-leucine-rich glioma inactivated protein 1 (LGI1) antibody-associated encephalitis, as well as the correlations between CSF and serum immunoglobulins in each group, and to explore their clinical value. Methods A total of 30 patients with anti-NMDAR encephalitis (anti-NMDAR encephalitis group) and 21 patients with anti-LGI1 antibody-associated encephalitis (anti-LGI1 antibody-associated encephalitis group) admitted to Tianjin Huanhu Hospital from January 2019 to January 2024 were selected. The concentrations of immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM) in CSF, as well as serum immunoglobulins (IgG, IgA, and IgM), were measured. CSF and serum immunoglobulin levels were compared between the two groups, and the correlations between CSF and serum immunoglobulins were analyzed in each group. Results There were no statistically significant differences in CSF or serum IgG and IgA between the anti-NMDAR encephalitis group and the anti-LGI1 antibody-associated encephalitis group (P>0.05). However, both CSF and serum IgM levels were significantly higher in the anti-NMDAR encephalitis group than in the anti-LGI1 antibody-associated encephalitis group (P<0.05). In the anti-NMDAR encephalitis group, CSF IgA was positively correlated with serum IgA (P<0.05), and CSF IgM was positively correlated with serum IgM (P<0.05). In the anti-LGI1 antibody-associated encephalitis group, CSF IgG was positively correlated with serum IgG (P<0.05), and CSF IgA was positively correlated with serum IgA (P<0.05).Conclusion CSF and serum immunoglobulin levels may provide an auxiliary reference for the clinical differentiation of anti-NMDAR encephalitis and anti-LGI1 antibody-associated encephalitis. Differences in the correlations between CSF and serum immunoglobulins in the two groups suggest possible heterogeneity in blood-brain barrier disruption and may involve different pathophysiological mechanisms.

Key words: anti-N-methyl-D-aspartic acid receptor encephalitis, anti-leucine-rich glioma inactivated protein 1 antibody-associated encephalitis, serum immunoglobulin, cerebrospinal fluid immunoglobulin

CLC Number:

R741

Zheng Xinwei. Clinical value of cerebrospinal fluid and serum immunoglobulins in the differential diagnosis of anti-NMDAR encephalitis and anti-LGI1 antibody-associated encephalitis[J]. Clinical Focus, 2026, 41(8): 711-715.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.08.007

https://www.lchc.cn/EN/Y2026/V41/I8/711

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References 24

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组别	例数	脑脊液IgG(mg/L)	脑脊液IgA(mg/L)	脑脊液IgM(mg/L)
抗NMDAR脑炎组	30	46.00(28.97, 65.40)	4.63(3.09, 6.81)	0.66(0.32, 1.56)
抗LGI1抗体相关脑炎组	21	43.00(28.35, 61.20)	4.19(2.76, 6.93)	0.35(0.23, 0.70)
Z值		-0.555	-0.268	-2.115
P值		0.579	0.789	0.034

组别	例数	脑脊液IgG(mg/L)	脑脊液IgA(mg/L)	脑脊液IgM(mg/L)
抗NMDAR脑炎组	30	46.00(28.97, 65.40)	4.63(3.09, 6.81)	0.66(0.32, 1.56)
抗LGI1抗体相关脑炎组	21	43.00(28.35, 61.20)	4.19(2.76, 6.93)	0.35(0.23, 0.70)
Z值		-0.555	-0.268	-2.115
P值		0.579	0.789	0.034

组别	例数	血清IgG(g/L)	血清IgA(g/L)	血清IgM(g/L)
抗NMDAR脑炎组	30	11.40(10.02, 15.10)	2.18(1.56, 3.02)	0.88(0.61, 1.11)
抗LGI1抗体相关脑炎组	21	11.40(9.38, 14.10)	2.40(1.71, 2.85)	0.66(0.38, 0.90)
Z值		-0.469	-0.727	-2.067
P值		0.639	0.467	0.039

组别	例数	血清IgG(g/L)	血清IgA(g/L)	血清IgM(g/L)
抗NMDAR脑炎组	30	11.40(10.02, 15.10)	2.18(1.56, 3.02)	0.88(0.61, 1.11)
抗LGI1抗体相关脑炎组	21	11.40(9.38, 14.10)	2.40(1.71, 2.85)	0.66(0.38, 0.90)
Z值		-0.469	-0.727	-2.067
P值		0.639	0.467	0.039

项目	脑脊液IgG		脑脊液IgA		脑脊液IgM
项目	r_s值	P值	r_s值	P值	r_s值	P值
血清IgG	-0.052	0.783	-0.284	0.129	0.053	0.780
血清IgA	-0.276	0.140	0.406	0.026	-0.064	0.738
血清IgM	0.159	0.402	0.170	0.369	0.678	0.000