脑脊液嗜酸性粒细胞比率升高对抗N-甲基-D-天冬氨酸受体脑炎患者的临床意义  

Clinical significance of high-proportion eosinophils in cerebrospinal fluid of autoimmune encephalitis patients associated with anti-NMDA receptor antibody

作　　者：张玉梅[1] 张巧全[1] 余年[2] 张燕芳[2] 宋坤[1] 王娟[1] 朱海青[1] ZHANG Yu-mei;ZHANG Qiao-quan;YU Nian(Department of Pathology,Nanjing Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院病理科,210029 [2]南京医科大学附属脑科医院神经内科,210029

出　　处：《临床神经病学杂志》2021年第3期177-180,共4页Journal of Clinical Neurology

基　　金：国家自然科学基金(81400981);南京市“十三五”卫生青年人才工程项目(QRX17179)。

摘　　要：目的探索CSF中嗜酸性粒细胞(EO)比率升高对抗N-甲基-D-天冬氨酸受体(NMDAR)自身免疫性脑炎患者的临床意义。方法收集临床确诊的抗NMDAR脑炎患者的临床资料,采用MGG染色法在发病初期(14 d内)对其行CSF细胞学分析。根据EO比率是否升高(>2%)分为升高组(CSF-EO组)和正常组(非CSF-EO组),比较两组的临床特征及预后;同时对其CSF淋巴细胞亚群进行计数,分析EO和各淋巴细胞亚群的相关性。结果共入组25例抗NMDAR脑炎患者,CSF-EO组为7例,均缺乏前驱感染表现,4例患者有相关基础疾病(分别为特发性EO增多综合征、慢性嗜酸粒细胞白血病、嗜酸性肉芽肿性血管炎和支气管哮喘),1例患者有长期"湿疹"病史,1例患者既往有弓形体感染,1例有食物过敏。CSF-EO组CSF中CD20细胞比率(即成熟B细胞)明显高于非-CSF-EO组(P=0.02)。CSF-EO组患者mRS评分明显高于非CSF-EO组(P=0.04)。结论CSF中EO比率升高的抗NMDAR脑炎患者缺少前驱感染症状,起病较慢,临床症状较重,可能和CSF中B细胞的激活有关,总体预后较差。Objective To explore the clinical significance of increased proportion of eosinophils(EO)in CSF in patients with anti-N-methyl-D-aspartate receptor(NMDAR)autoimmune encephalitis.Methods The clinical data of patients definitely diagnosed as anti-NMDAR encephalitis were collected,and the CSF cytology of them were analyzed by the MGG method at the initial stage(within 14 d).According to whether the proportion(>2%)of EO in CSF,they were classified into elevated group(CSF-EO group)and normal group(non-CSF-EO group).The clinical characteristics and prognosis of the two groups were compared;meanwhile,the CSF lymphocyte subsets were counted,and the correlation between EO and lymphocyte subsets was analyzed.Results A total of 25 patients with anti-NMDAR encephalitis were enrolled in this study.Among them,7 patients of CSF-EO group were all lack of preinfection manifestations,and 4 patients of them had related underlying diseases(idiopathic eosinophilia syndrome,chronic eosinophilic leukemia,eosinophilic granulomatous vasculitis and bronchial asthma respectively),1 patient had a long-term history of"eczema",1 patient had a previous toxoplasma infection,and another one harbored food allergies.The CSF CD20 cell ratio(as mature B cells)in CSF-EO group was significantlly higher than that in nonCSF-EO group(P=0.02).The mRS scores in CSF-EO group were significantly higher than those in non-CSF-EO group.Conclusions The anti-NMDAR encephalitis patients with higher level of EO in CSF lack typical symptoms of precursor infection,and the disease onset is relatively slower.Their clinical symptoms are severer,which may be associated with the activation of B cells in the CSF,and the overall prognosis of them is poor.

关 键 词：抗N-甲基-D-天冬氨酸受体 CSF 嗜酸性粒细胞 自身免疫性脑炎 

分 类 号：R512.3[医药卫生—内科学]