免疫球蛋白及相关抗体检测在自身免疫性脑炎诊断中的应用  

Application of immunoglobulin and related antibody detection in the diagnosis of autoimmune encephalitis

作　　者：张海军[1] 易小艳[2] 程宇锋 ZHANG Hai-jun;YI Xiao-yan;CHENG Yu-feng(Department of Neurology,People's Hospital of Anyang,Anyang 455000,China;Department of Psychiatry,Wuhan Mental Health Center,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Mental Health,Hebei Friendship Hospital,Shijiazhuang 050000,China)

机构地区：[1]安阳市人民医院神经内科,安阳455000 [2]华中科技大学同济医学院附属武汉市精神卫生中心精神科,武汉430022 [3]河北友爱医院精神卫生科,石家庄050000

出　　处：《现代免疫学》2019年第5期384-388,共5页Current Immunology

基　　金：河北省卫生和计划生育委员会医学科学研究课题计划项目(20171515)

摘　　要：为探讨血清Ig、脑脊液Ig及自身免疫性脑炎(autoimmune encephalitis,AE)相关抗体检测在首发认知和精神行为异常的AE诊断中的应用价值,选取56例AE患者为试验组,56例病毒性脑炎患者为对照组。对比2组患者血清IgM、血清IgG、脑脊液IgG水平,脑脊液白蛋白/血清白蛋白比值,IgG指数及血清、脑脊液AE相关抗体检出情况。试验组均予以激素、Ig等系统治疗,比较试验组治疗前后血清IgM、血清IgG、脑脊液IgG水平,脑脊液白蛋白/血清白蛋白比值及IgG指数。结果显示,试验组血清IgM、血清IgG、脑脊液IgG水平,脑脊液白蛋白/血清白蛋白比值,IgG指数及IgG指数>0.7的人数比例均高于对照组(P<0.05);试验组抗N-甲基-D-天冬氨酸(anti-N-methyl-D-aspartate,NMDA)受体抗体、抗富亮氨酸胶质瘤失活1蛋白(leucine-rich glioma inactivation 1 protein,LGI1)抗体检出率均高于对照组(P<0.05);试验组治疗后血清IgM、血清IgG、脑脊液IgG水平,脑脊液白蛋白/血清白蛋白比值及IgG指数均较治疗前降低(P<0.05)。提示首发认知和精神行为异常的AE患者血清、脑脊液Ig水平明显升高,且存在不同类型AE相关抗体,血清、脑脊液Ig水平也与疾病病程进展密切相关,可将其作为疾病早期诊断及病程监测的重要指标。To explore the value of serum Ig, cerebrospinal fluid Ig and autoimmune encephalitis(AE)-related antibody detection in the diagnosis of AE with first-episode cognitive and mental behavior abnormalitie, we selected 56 patients with AE as the test group and 56 patients with viral encephalitis as the control group. The serum IgM, serum IgG, cerebrospinal fluid IgG, cerebrospinal fluid albumin/serum albumin ratios, IgG indexes and AE-related antibodies in serum and cerebrospinal fluid of the two groups were detected and compared. The test group was treated with hormone and Ig. The levels of serum IgM, serum IgG, cerebrospinal fluid IgG and IgG index were compared before and after treatment. The results showed that the levels of serum IgM, serum IgG, cerebrospinal fluid IgG and IgG index, IgG index exceeding 0.7 in the test group were higher than those in the control group(P < 0.05). The detection rates of anti-N-methyl-D-aspartate(NMDA) receptor antibody and leucine-rich glioma inactivation 1 protein(LGI1) antibody in the test group were higher than those in the control group(P < 0.05). The levels of serum IgM, serum IgG, cerebrospinal fluid IgG and IgG index in the test group after treatment were lower than those before treatment(P < 0.05). Our study suggests that serum and cerebrospinal fluid Ig levels in patients with AE with first-episode cognitive and mental behavior abnormalitie are significantly elevated. The elevations of different types of AE-related antibodies, and serum and cerebrospinal fluid Ig levels are closely related with the progress of the disease and could be used as an important indicator for early diagnosis and disease monitoring.

关 键 词：自身免疫性脑炎 认知和精神行为异常 免疫球蛋白M 免疫球蛋白G 免疫球蛋白G指数 抗体 

分 类 号：R373.3[医药卫生—病原生物学]