结核性脑膜炎的伪装者:自身免疫性胶质纤维酸性蛋白星型细胞病  

The masquerader of tuberculosis meningitis:autoimmune glial fibrillary acidic protein astrocytopathy

作　　者：张佳源 谭杰[1] 黄啟铧 陈子轩 汪玉盈 林沛豪 龙友明[1] ZHANG Jia-yuan;TAN Jie;HUANG Qi-hua;CHEN Zi-xuan;WANG Yu-ying;LIN Pei-hao;LONG You-ming(The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院,广东广州510260

出　　处：《实用医院临床杂志》2023年第6期7-10,共4页Practical Journal of Clinical Medicine

基　　金：国家自然科学基金面上项目(编号:81771302);广州市科技计划项目(编号:202002020021);广州医科大学学生创新能力提升计划。

摘　　要：自身免疫性胶质纤维酸性蛋白星型细胞病(autoimmune glial fibrillary acidic protein astrocytopathy,A-GFAP-A)作为一种新发现的自身免疫性中枢神经系统炎症性疾病,可以导致脑膜脑脊髓炎、运动障碍、视力模糊、癫痫等临床表现。该疾病与结核性脑膜炎(tuberculosis meningitis,TBM)在临床症状、影像学和脑脊液检查方面有许多相似之处,已有多例国内外的误诊案例报道。A-GFAP-A诊治的延误可引起严重的后果,作者在分析多个误诊案例的基础上提出了若干鉴别诊断的建议:分析患者的血液特征、炎症指标,以及脑脊液中腺苷脱氨酶(adenosine deaminase,ADA)水平、淋巴细胞数量和蛋白质含量的变化并结合GFAP-IgG抗体检测和A-GFAP-A特有的影像学征象进行鉴别,以期降低A-GFAP-A在临床中的误诊率。Autoimmune glial fibrillary acidic protein astrocytopathy(A-GFAP-A)is a newly discovered autoimmune inflammatory disease of the central nervous system.The disease has clinical manifestations such as meningitis,movement disorders,blurred vision,and epilepsy.The disease exhibits numerous similarities to tuberculous meningitis(TBM)in terms of clinical symptoms,imaging and cerebrospinal fluid examination.There have been several reported cases of misdiagnosis worldwide.Delay in the diagnosis and treatment of the disease can lead to serious consequences.Based on the analysis of multiple misdiagnosis cases,the authors have put forward several suggestions for differential diagnosis of A-GFAP-A.These suggestions include the analysis of the blood characteristics and inflammatory indicators as well as levels of adenosine deaminase(ADA),lymphocyte number and protein content in the cerebrospinal fluid.These indexes combined with GFAP-IgG antibody detection and unique imaging signs of A-GFAP-A could identify this disease.These measures may reduce the misdiagnosis rate of A-GFAP-A in clinical practice.

关 键 词：自身免疫性胶质纤维酸性蛋白星型细胞病 结核性脑膜炎 鉴别诊断 

分 类 号：R74[医药卫生—神经病学与精神病学]