共病髓鞘少突胶质细胞糖蛋白抗体病误诊为精神分裂症复发1例  

Comorbid myelin oligodendrocyte glycoprotein antibody disease misdiagnosed as relapse of schizophrenia: a case report and literature review

作　　者：陈扬波[1] 李娜[1] 张凯 谢婷 Chen Yangbo;Li Na;Zhang Kai;Xie Ting(Department of Psychiatric and Geriatric Critical Medicine,Tongde Hospital of Zhejiang Province,Hangzhou 311122,China)

机构地区：[1]浙江省立同德医院精神老年重症医学科,杭州311122

出　　处：《中华精神科杂志》2023年第3期221-226,共6页Chinese Journal of Psychiatry

基　　金：浙江省基础公益研究计划项目(LGF22H150011);浙江省中医药科技项目(2021ZQ017);浙江省医药卫生科技计划项目(2023KY620)。

摘　　要：髓鞘少突胶质细胞糖蛋白(myelin oligodendrocyte glycoprotein,MOG)抗体介导的特发性炎性脱髓鞘疾病(idiopathic inflammatory demyelinating disease,IIDDs),简称为MOG抗体病。MOG抗体病临床表现多样,但以精神症状发作起病较少见报道。本例为42岁女性精神分裂症患者,以精神症状发作起病就诊,当地医院诊断为精神分裂症复发,超常规调整精神药物从而导致恶性综合征发生,加重了病情,并产生休克、多脏器功能衰竭等附加损害。在我院检查患者存在行为与精神异常、左侧眼睑下垂、左眼视力下降、视物模糊、步态不稳、左侧肢体肌力Ⅲ级、肌张力亢进、腱反射减弱等症状和体征,颅脑MRI提示:脑干、双侧丘脑、双侧额叶脑沟内异常信号,血清MOG抗体阳性。结合患者临床特征和MOG抗体病诊断标准,诊断为MOG抗体病,经过激素、丙种球蛋白冲击及营养神经等治疗后症状缓解。本文中对患者临床资料进行分析并进行相关文献复习,旨在探讨MOG抗体病临床表现特点,帮助临床医生提高警惕,防止漏诊、误诊此病。Idiopathic Inflammatory Demyelinating Diseases(IIDDs)mediated by Myelin oligodendrocyte glycoprotein(MOG)antibodies,also known as MOG antibody diseases.The clinical manifestations of MOG antibody disease are diverse,but the onset of mental symptoms has been rarely reported.This case is a 42-year-old female patient with schizophrenia who was diagnosed with an onset of mental symptoms.Clinicians in the patient′s local hospital diagnosed her as a recurrence of schizophrenia,and unconventional adjustment of psychotropic drugs led to the occurrence of malignant syndrome,exacerbating the patient′s condition,and causing additional damage such as shock and multiple organ failure.The patient showed significant behavioral and mental abnormalities,left eyelid ptosis,decreased left eye vision,blurred vision,unstable walking,gradeⅢleft limb muscle strength,hypertonia,and weakened tendon reflex.Brain MRI showed abnormal signals in the brainstem,bilateral thalamus,and bilateral frontal sulcus,with positive test results of MOG antibodies.Based on the clinical characteristics of the patient and the diagnostic criteria for MOG antibody disease,the patient was diagnosed as MOG antibody disease.Patient′s symptoms showed improvement after treatment with hormones,gamma globulin stimulation,and neurotrophic agent.This article reviews the clinical data of patient and reviews relevant literature,aiming to explore the clinical manifestations of MOG antibody disease,help health professionals to increase vigilance,and prevent missed diagnosis and misdiagnosis of this disease.

关 键 词：精神分裂症 髓鞘少突胶质细胞糖蛋白 特发性炎性脱髓鞘疾病 恶性综合征 误诊 

分 类 号：R744.5[医药卫生—神经病学与精神病学]