多重抗神经节苷脂抗体阳性的复发型米勒-费希尔综合征1例  

A case of recurrent Miller-Fisher syndrome with multiple anti-ganglioside antibodies

作　　者：叶圆圆 田志岩[1] 王盼 张惠红[1] 周玉颖[1] 李攀[1] Ye Yuanyuan;Tian Zhiyan;Wang Pan;Zhang Huihong;Zhou Yuying;Li Pan(Department of Neurology,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院神经内科,天津300350

出　　处：《中国综合临床》2023年第1期57-60,共4页Clinical Medicine of China

基　　金：天津市卫生健康科技项目(TJWJ2021MS029);天津市医学重点学科(专科)建设项目(TJYXZDXK-052B)。

摘　　要：吉兰-巴雷综合征(Guillain-Barrésyndrome,GBS)系一类免疫介导的急性炎症性周围神经病。米勒-费希尔综合征(Miller-Fisher syndrome,MFS)是GBS的一种特殊变异型,大多呈单向病程,临床复发罕见。现报道1例因视物成双伴四肢麻木进行性加重就诊的青年男性患者,急性起病,发病前有上呼吸道感染症状,伴瞳孔异常、自主神经功能障碍。既往3年前因相似症状就诊我院,经免疫治疗好转。该患者有眼肌麻痹、腱反射消失和共济失调三联征表现,脑脊液呈蛋白-细胞分离,血清抗硫脂抗体免疫球蛋白M(immunoglobulin M,IgM)(+),抗GT1a抗体免疫球蛋白G(immunoglobulin G,IgG)(+),抗GQ1b抗体IgG(++),抗单唾液酸神经节苷脂(monosialoganglioside 3,GM3)抗体IgM(+),诊断复发型MFS,经免疫治疗后预后良好。提示MFS具有临床异质性,少数患者可出现复发,一般经免疫治疗预后较好。前驱感染、抗GQ1b抗体可能是MFS复发的诱导因素。Guillain-Barrésyndrome(GBS)defines a kind of Immune-mediated acute inflammatory peripheral neuropathy.Miller-Fisher Syndrome(MFS)is a special variant of GBS,with mostly one-way course and rare clinical recurrence.Only a few recurrent cases have been reported in China.Here we report a case of a young male patient with double vision and progressive aggravation of limb numbness,acute onset,with symptoms of upper respiratory tract infection before onset,accompanied by pupil abnormalities and autonomic nervous dysfunction,who was was admitted to our hospital for similar symptoms 3 years ago and was improved by immunotherapy.The patient had a triad of“ataxia,areflexia and ophthalmoplegia”.Cerebrospinal fluid showed protein-cell separation.Serum anti-Sulfatides antibody IgM,anti-GT1a antibody IgG,anti-GQ1b antibody IgG and anti-GM3 IgM were positive.Recurrent MFS was diagnosed and the symptoms improved after immunotherapy.This case suggests that MFS is clinically heterogeneous,a few patients can present with relapse and generally have a better prognosis with immunotherapy.Pre-existing infection and anti-GQ1b antibody production may be predisposing factors for MFS recurrence.

关 键 词：吉兰-巴雷综合征 复发型米勒-费希尔综合征 抗神经节苷脂抗体 抗GQ1b抗体 

分 类 号：R745[医药卫生—神经病学与精神病学]