关于中国抗γ-氨基丁酸B受体脑炎患者叠加多种自身抗体的临床分析  

Clinical analysis of anti-γ-aminobutyric acid B receptor autoimmune encephalitis with co-existence of multiple antibodies in Chinese populations

作　　者：余年[1] 林兴建[1] 张燕芳[1] 狄晴[1] 石静萍[1] Yu Nian;Lin Xingjian;Zhang Yanfang;Di Qing;Shi Jingping(Department of Neurology,the Nanjing Brain Hospital Affiliated Nanjing Medical University,Jiangsu 210029,China)

机构地区：[1]南京医科大学附属脑科医院神经内科,江苏210029

出　　处：《脑与神经疾病杂志》2020年第7期410-414,共5页Journal of Brain and Nervous Diseases

基　　金：南京市十三五青年卫生人才项目(QRX17179);南京医科大学附属脑科医院青年人才项目(682);国家自然科学基金资助(81400981)

摘　　要：目的探讨中国抗γ-氨基丁酸B(GABA-B)受体脑炎患者合并多种抗神经元抗体及系统性自身抗体的临床意义。方法分析本院2015年1月-2019年1月诊断的抗GABA-B受体脑炎患者情况,并系统性检索同时期已发表的关于我国抗GABA-B受体脑炎患者临床研究文献,对其合并抗神经元抗体及系统性自身抗体情况及临床意义进行荟萃分析。结果4年期间,本院共确诊4例抗GABA-B受体脑炎患者;对全国所有已发表的关于抗GABA-B受体脑炎患者的荟萃分析,共纳入确诊92例,中位年龄数为57岁(18~79岁),男性68例(73.9%),女性24例(26.1%);共29例(31.5%)患者检测到一种或多种叠加抗体,其中神经元抗体以抗Hu抗体最常见,11例(37.93%),其次为抗NMDAR抗体5例(17.24%),抗Ma2、Yo、CV2、CASPR2抗体各1例,系统性自身抗体以甲状腺相关抗体最为常见,占7例(24.14%)。叠加抗体组患者合并肿瘤占16例(55.2%),高于无叠加抗体组33.3%(P=0.04),其中以抗Hu抗体组合并肿瘤占比最高8/11例(72.7%)。所有入组患者随访时间为0.5~33个月,中位时间8个月,共死亡23例(25.56%),抗神经元抗体组病死率7/18,高于系统性自身抗体组2/11(P=0.036)。结论中国抗GABA-B受体脑炎患者合并其他自身抗体较常见,其中叠加抗神经元抗体提示合并恶性肿瘤可能性大,预后较差,病死率高;而合并的系统性自身抗体未发现与病情及预后的相关性。Objective To explore the clinical significance of combing multiple autoantibodies including the anti-neuronal antibodies and the systematic antibodies in Chinese patients with anti-γ-aminobutyric acid B(GABA-B)receptor autoimmune encephalitis.Methods The anti-GABA-B receptor encephalitis patients diagnosed in our hospital and in the published literatures by systematically retrieving from Jan.2015 to Jan.2019 were recruited in the current study.Systematic analysis was performed to clarify the clinical significance of co-existence of antineuronal antibodies or systemic autoantibodies.Results During the 4-year period,4 patients with anti-GABA-B receptor encephalitis were diagnosed in our hospital.Plus with the published literatures on Chinses patients,there were totally 92 patients with anti-GABA-B receptor encephalitis according to the including criteria.The median age was 57 years(18-79 years)with 68 males(73.9%)and 24 females(26.1%).One or more plus antibodies were detected of 31.5%(29 cases)patients,among whom the neuronal antibodies were most common:with 37.93%(11 cases)of antiHu antibody,followed by 5 cases(17.24%)of anti-NMDAR antibody,1 case of anti-Ma2,Yo,CV2,and CASPR2 antibodies,respectively.The most common systemic autoantibodies were the thyroid-related antibodies,accounting for 24.14%(7 cases).In the combined-antibody group,16 patients(55.2%)had tumors,which was higher than that in the non-combined antibody group(33.3%)(P=0.04).The plus anti-Hu antibody had the highest tumor ratio of 72.7%(8/11 cases).The follow-up time of all enrolled patients was 0.5-33 months,with the median time of 8 months.Totally 23 patients(25.56%)died during the follow-up.The mortality of anti-neuronal antibody group was 7/18,which was higher than that of the systemic autoantibody group(2/11)(P=0.036).Conclusions Chinese anti-GABA-B receptor encephalitis patients plus with other antibodies are much common.The combined anti-neuronal antibodies suggest that the possibility of malignant tumors is higher,with the poor prognosis an

关 键 词：中国 抗GABA-B受体脑炎 自身抗体 荟萃分析 

分 类 号：R742.9[医药卫生—神经病学与精神病学]