机构：[1]Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China[2]Department of Neurology, The Third Affiliated Hospital of sun Yat-Sen University, Guangzhou, Guangdong, China中山大学附属第三医院[3]Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China[4]Department of Neurology, Guangdong 999 Brain Hospital, GuangZhou, Guangdong, China[5]Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China神经科系统神经内科首都医科大学宣武医院[6]Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China[7]Department of Neurology, The Second Affiliated Hospital of Army Medical University, Chongqing, China[8]Department of Neurology, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China[9]Department of Neurology, Tangshan Gongren Hospital, Tangshan, Hebei, China[10]Department of Neurology, Jining no. 1 People's Hospital, Jining, Shandong, China[11]Department of Neurology, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China[12]Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China[13]Department of Neurology, The First Affiliated Hospital of sun Yat-Sen University, Guangzhou, Guangdong, China中山大学附属第一医院[14]Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China[15]Department of Neurology, Shantou Central Hospital, Shantou, Guangdong, China[16]Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China深圳市康宁医院深圳市人民医院深圳医学信息中心中国医科大学附属盛京医院中国医科大学盛京医院[17]Department of Neurology, The Second People's Hospital of Foshan, Foshan, Guangdong, China[18]Department of Neurology, People's Hospital of Chongqing Banan District, Chongqing, China
Background: Glial fibrillary acidic protein-immunoglobulin G (GFAP-IgG) positivity is associated with autoimmune GFAP astrocytopathy (GFAP-A), but also with other autoimmune encephalitides and viral infections. We attempted to elucidate the characteristics of GFAP-A in relation to other GFAP-IgG-positive encephalitides and constructed a differential diagnosis model. Methods: 141 GFAP-IgG-positive cases were identified, including 52 astrocytopathy (GFAP-A group), 48 autoimmune encephalitis (AE-G), and 41 viral encephalitis (VE-G). Multivariate logistic regression was employed to create a diagnostic model, with validation using an external cohort. Result: Compared to the AE-G group, the GFAP-A patients showed more onset age >= 50 years, headache, fever, consciousness disturbance, MRI radial vascular enhancement, cerebrospinal fluid (CSF) antibody titer grade >= 4, and CSF proteins >= 700 mg/L, but less female sex, limb numbness, visual disturbances, and CSF chloride <= 120 mmol/L. Among these, CSF antibody titer grade >= 4, CSF protein >= 700 mg/L, and absence of visual disturbances were independent risk factors for GFAP-A diagnosis. Compared to the VE-G group, the GFAP-A patients showed more course >= 14 days, onset age >= 50 years, limb weakness, serum potassium <= 3.9 mmol/L, CSF antibody titer grade >= 4, CSF leukocytes <= 46*10, MRI radial vascular enhancement, MRI involvement of brainstem, and MRI involvement of spinal cord, but less headache, fever, nausea, and vomiting. Among these, serum potassium <= 3.9 mmol/L, MRI spinal cord involvement, and absence of nausea and vomiting were independent risk factors for GFAP-A diagnosis. Conclusions: Based on critical clinical indicators identified, we constructed a differential diagnosis model for GFAP-A.
基金：
Guangzhou Medical Key Discipline Construction Project (2025-2027)
第一作者机构：[1]Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
通讯作者：
推荐引用方式(GB/T 7714)：
Zhang Shifeng,Li Huilu,Lin Peihao,et al.A Comparative Study of 141 Glial Fibrillary Acidic Protein Immunoglobulin G Positive Cases[J].EUROPEAN JOURNAL OF NEUROLOGY.2025,32(3):doi:10.1111/ene.70102.
APA：
Zhang, Shifeng,Li, Huilu,Lin, Peihao,Liu, Ding,Wang, Zhanhang...&Long, Youming.(2025).A Comparative Study of 141 Glial Fibrillary Acidic Protein Immunoglobulin G Positive Cases.EUROPEAN JOURNAL OF NEUROLOGY,32,(3)
MLA：
Zhang, Shifeng,et al."A Comparative Study of 141 Glial Fibrillary Acidic Protein Immunoglobulin G Positive Cases".EUROPEAN JOURNAL OF NEUROLOGY 32..3(2025)
