抗GD3 IgG抗体阳性的急性共济失调神经病的临床特点(附1例报告)  

Clinical characteristics of acute ataxic neuropathy with anti-GD3 IgG antibody positivity(report of one case)

作　　者：王静雯 陈响亮 时建铨 周俊山[1] 张颖冬[1] 赵红东[1] WANG Jing-wen;CHEN Xiang-liang;SHI Jian-quan(Department of Neurology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)神经内科,210006

出　　处：《临床神经病学杂志》2021年第2期126-129,共4页Journal of Clinical Neurology

摘　　要：目的探讨抗GD3 IgG抗体阳性的不完全Miller Fisher综合征(MFS)的亚型急性共济失调神经病的发病机制和临床特点。方法回顾性分析1例抗GD3 IgG抗体阳性的不完全MFS的亚型急性共济失调神经病患者的临床资料并文献复习。结果本例患者为69岁女性,急性起病。发病前有上呼吸道感染史。因"行走不稳20 d"入院。神经系统查体提示双侧腱反射对称减弱,上下肢共济失调。电生理检查未见异常。CSF可见蛋白-细胞分离,血抗GD3 IgG抗体(+)。该患者诊断为急性共济失调神经病,在接受0.4 g/(kg·d)免疫球蛋白静脉注射治疗5 d后症状好转。结论经典MFS以急性起病的眼外肌麻痹、腱反射消失/减弱、共济失调三联征为主要临床表现,而不完全MFS仅出现MFS经典三联征中的一种或两种症状,其中一型为急性共济失调神经病。多数MFS患者抗GQ-1b IgG抗体阳性。静脉注射免疫球蛋白治疗有效。Objective To explore the pathogenesis and clinical characteristics of IgG anti-GD3 positive acute ataxic neuropathy,an incomplete form of Miller Fisher syndrome(MFS).Methods The clinical data of one patient diagnosed with IgG anti-GD3 positive acute ataxic neuropathy,an incomplete form of MFS were retrospectively analyzed,and the literatures were reviewed.Results The patient was a 69-year-old woman with acute onset of gait unsteadiness for 20 d following an upper respiratory tract infection.Neurological examination indicated bilateral,symmertrical hyporeflexia and limb ataxia.The electrophysiologic examination was normal.CSF was notable for albuminocytological dissociation and positive testing for serum GD3-IgG antibody.A diagnosis of acute ataxic neuropathy was made,and the patient was treated with 0.4 g/(kg·d)intravenous immunoglobulin for 5 d,which resulted in a resolution of the neurological features.Conclusions MFS is typically characterized by the acute onset of the clinical triad of ophthalmoplegia,areflexia/hyporeflexia,and ataxia.The incomplete forms of MFS are presented with only one or two cardinal features,one of which is acute ataxic neuropathy.Most MFS patients are IgG anti-GQ-1 b positive.Intravenous immunoglobulin therapy is effective.

关 键 词：Miller Fisher综合征 不完全 急性共济失调神经病 抗GD3 IgG抗体 抗GQ-1b抗体 

分 类 号：R745.43[医药卫生—神经病学与精神病学]