自身抗体在自身免疫性脑炎中临床价值分析  

An Analysis of the Clinical Value of Autoantibodies in Autoimmune Encephalitis

作　　者：张艳芳 张楠 王丹[1] 韩平 刘紫薇 张丽敏[1] ZHANG Yanfang;ZHANG Nan;WANG Dan;HAN Ping;LIU Ziwei;ZHANG Limin(Experimental Diagnosis Center,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院实验诊断中心,北京100070

出　　处：《标记免疫分析与临床》2024年第6期1103-1109,共7页Labeled Immunoassays and Clinical Medicine

基　　金：首都医科大学本科生科研创新项目(编号:XSKY2024391)。

摘　　要：目的全身性自身抗体对自身免疫性疾病的诊断很重要,但其在自身免疫性脑炎(autoimmune encephalitis,AE)中的作用尚不清楚。本研究的目的是探讨自身抗体在自身免疫性脑炎中临床价值。方法评估抗NMDAR脑炎患者和其他形式自身免疫性脑炎患者的全身性自身抗体,根据自身抗体将脑炎患者分为抗核抗体(ANA)阳性组和(ANA)阴性组进行分组比较。结果共纳入194例AE患者进行了抗核抗体谱检测,结果显示AE中自身抗体总体阳性率为35.10%,70例抗NMDAR脑炎患者中抗体的阳性率(32.86%),显著高于49例抗LGI1脑炎患者(26.53%),其中以低滴度的ANA荧光核型常见,荧光核型主要以核颗粒型多见;ANA不同组中血清神经元抗体滴度差异具有统计学意义(P=0.032),说明血清自身抗体与血清中神经元抗体具有相互作用。结论自身抗体在自身免疫性脑炎患者检测中具有重要意义,阳性可能通过与针对神经元表面抗原与抗体相互作用而导致大脑的免疫功能紊乱,常见的自身抗体甚至到荧光核型可能为患者初步诊疗制定提供重要参考。Objective Systemic autoantibodies are important for the diagnosis of autoimmune diseases,but their roles in autoimmune encephalitis(AE)remain unclear as of today.The purpose of this study was to explore the clinical value of autoantibodies in autoimmune encephalitis.Methods The systemic autoantibodies of patients with anti-NMDAR encephalitis and other forms of autoimmune encephalitis were evaluated,and encephalitis patients were divided into anti-nuclear antibody(ANA)positive group and anti-nuclear antibody(ANA)negative group according to the status of autoantibodies.Results A total of 194 patients with AE were tested for antinuclear antibody spectrum.The results showed that the overall positive rate of autoantibodies in AE was 35.10%,and the positive rate of antibodies in 70 patients with anti-NMDAR encephalitis was 32.86%,which was significantly higher than that in 49 patients with anti-LGI1 encephalitis(26.53%).The low titer ANA fluorescent karyotype was common,and the fluorescent karyotype was mainly nuclear granular type;There was a statistically significant difference in the titer of serum neuron antibody among different groups of ANA(P=0.032),indicating that there was an interaction between serum autoantibody and serum neuron antibody.Conclusion Autoantibodies are of great significance in the detection of patients with autoimmune encephalitis.Positive autoantibodies might cause immune dysfunction of the brain by interacting with antibodies against neuronal surface antigens.Common autoantibodies and even fluorescent karyotypes could provide important references for the initial diagnosis and treatment.

关 键 词：自身免疫性脑炎 自身抗体 临床特征 抗核抗体 

分 类 号：R593.9[医药卫生—内科学]