双重抗体阳性自身免疫性脑炎临床特点及预后分析  

Clinical characteristics and prognosis of double antibody positive autoimmune encephalitis

作　　者：傅建梅 陈珉 FU Jianmei;CHEN Min(Department of Neurology,the First Hospital of Putian City,Fujian Province,Putian351100,China)

机构地区：[1]福建省莆田市第一医院神经内科,福建莆田351100

出　　处：《中国当代医药》2022年第34期112-115,119,共5页China Modern Medicine

摘　　要：目的分析双重抗体阳性自身免疫性脑炎(AE)的临床特点、治疗及转归。方法选取2016年1月至2021年7月在莆田市第一医院收治的5例双重抗体阳性AE患者作为研究对象,分析患者临床表现、抗体检测、影像学结果、治疗及转归情况。结果5例患者中,1例为抗N-甲基-D-天冬氨酸受体(NMDAR)抗体并抗a氨基-3-羟基-5-甲基-4-异唑酸受体(AMPAR1)抗体阳性,2例为抗γ-氨基丁酸B型受体(GABABR)抗体并抗神经细胞核1型(Hu)抗体阳性,1例富亮氨酸胶质瘤失活1蛋白(LGI1)抗体并髓鞘少突胶质细胞糖蛋白(MOG)抗体阳性,1例为抗RhoGTP酶活化蛋白26(ARHGAP26)抗体并抗浦肯野细胞抗原1型(Yo)抗体阳性。其中4例经糖皮质激素和丙种球蛋白冲击治疗后病情均好转,1例病情危重自动出院;随访余4例6个月,2例合并肺癌患者AE复发,后遗留不同程度记忆力及智能减退,余2例预后较好。结论双重抗体阳性AE患者临床上较少见,可表现边缘性脑炎或小脑性共济失调等,其抗体重叠形式不一,合并恶性肿瘤患者预后较差。Objective To analyze the clinical characteristics,treatment and prognosis of double antibody positive autoimmune encephalitis(AE)patients.Methods A total of 5 patients with double antibody positive AE in the First Hospital of Putian City from January 2016 to July 2021 were selected as the research subjects.Their clinical symptom,antibody,imaging examination,treatment and prognosis were analyzed.Results Among these patients,1 case was positive for anti-N-methyl-D-aspartate receptor(NMDAR)and anti-α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor(AMPAR1)antibody,2 cases were positive for anti-γ-aminobutyric acid B type receptor(GABABR)and anti-antineuronal nuclear antibodies 1(Hu)antibody,1 case was positive for anti-leucine-rich glioma inactivated 1(LGI1)and anti-myelin oligodendrocyte glycoprotein(MOG)antibody,and 1 case was positive for anti-Rho GTPase activating protein 26(ARHGAP26)and anti-Hu antibody,4 cases were effectively improved by glucocorticosteroid pulse and immunoglobulin therapy and 1 case was automatic discharge because of critical ill.The other 4 cases had been followed up for 6 months.Tow patients with lung cancer recurred after several months then remained hypomnesis and mental retardation.The other two patients had good prognosis during follow-up.Conclusion Double antibody positive AE is rare.It presents as marginal encephalitis,cerebellar ataxia and so on.The antibody's overlapping forms are different.The patients with tumor have poor prognosis.

关 键 词：自身免疫性脑炎 双重抗体 边缘性脑炎 临床特点 

分 类 号：R742.9[医药卫生—神经病学与精神病学]