蛋白A免疫吸附治疗自身免疫脑炎疗效的回顾性分析  

A retrospective study of protein A immunoadsorption therapy in autoimmune encephalitis

作　　者：王玉鸽[1] 马晓宇 杨渝[1] 常艳宇 李蕊[1] 陈小东 张炳俊[1] 余波光 陆正齐[1] 胡学强[1] 邱伟[1] 舒崖清[1] WANG Yuge;MA Xiaoyu;YANG Yu;CHANG Yanyu;LI Rui;CHEN Xiaodong;ZHANG Bingjun;YU Boguang;LU Zhengqi;HU Xueqiang;QIU Wei;SHU Yaqing(不详;Department of Neurology,the Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院神经内科,510630 [2]广东省血液净化吸附技术企业重点实验室,510660

出　　处：《中国神经免疫学和神经病学杂志》2021年第3期224-227,共4页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家自然科学基金资助项目(NO.82071343,NO.81701188);广东省自然基金面上项目(2021A1515010393)。

摘　　要：目的探索蛋白A免疫吸附治疗对自身免疫性脑炎(AE)的疗效及安全性。方法回顾性收集作者医院收治的24例对一线治疗反应不佳的AE住院患者,其中抗N-甲基-D-天冬氨酸受体(NMDAR)抗体阳性20例,抗γ-氨基丁酸B型受体(GABA BR)阳性2例,抗富含亮氨酸胶质瘤失活蛋白1(LGI1)阳性1例,抗IgLON5阳性1例。比较免疫吸附前后AE患者改良Rankin量表评分(mRS)、血及脑脊液特异性抗体滴度、脑脊液细胞数及蛋白水平,血IgG水平及补体C3、C4水平变化。结果24例患者经吸附治疗后21例(87.5%)mRS评分至少下降1分。与免疫吸附治疗前比较,治疗后患者mRS评分(P=0.000)、血及脑脊液抗体滴度(P=0.000,P=0.006)、血IgG水平(P=0.000)、脑脊液细胞数(P=0.002)、血补体C3水平(P=0.000)、血C4水平(P=0.037)均下降,而脑脊液蛋白水平未见统计学变化。24例患者中2例患者出现低血压、1例心率加快,经对症处理好转并均耐受整个治疗过程。结论免疫吸附可有效地改善AE病情,且耐受性良好,其在AE中的确切疗效尚需更大样本的前瞻性研究验证。Objective To evaluate the efficacy and safety of protein A immunoadsorption(IA)treatment in autoimmune encephalitis(AE).Methods 24 AE patients irresponsive to first-line therapy with positive anti-N-methyl-D-aspartate receptor(NMDAR)(n=20),anti-γ-aminobutyric acid type B receptor(GABA BR)(n=2),anti-leucine-rich glioma inactivated 1(LGI1)(n=1),anti-lgLON5(n=1)antibodies were recruited from the Third Affiliated Hospital of Sun Yat-Sen University retrospectively.Modified Rankin Scale(mRS),specific antibody titer in blood and cerebrospinal fluid(CSF),white blood cells(WBC)count and protein level in CSF,and serum IgG,complement C3,C4 level were assessed before and after immunoadsorption.Results 87.5%(21/24)of the patients exhibited clinical improvement with mRS decline≥1 after IA treatments.Compared to those before treatment,mRS(P=0.000),specific antibody titer in blood(P=0.006)and CSF(P=0.000),serum IgG level(P=0.000),WBC in CSF(P=0.002),serum complement C3(P=0.000),and C4(P=0.037)reduced significantly after treatment in these patients.In the study,most of the patients could tolerate IA treatment,only 2 patients experienced hypotension and 1 patient experienced tachycardia.Conclusions IA is potentially effective and well-tolerated in AE patients,which should be validated by larger-scale prospective studies in future.

关 键 词：免疫吸附技术 免疫球蛋白A 自身免疫性脑炎 抗NMDAR抗体 

分 类 号：R742[医药卫生—神经病学与精神病学]