抗γ-氨基丁酸B受体抗体脑炎的临床与影像学表现特征分析  

Analysis of clinical and imaging characteristics of anti-GABA_(B)R encephalitis

作　　者：张晶亮 郭守刚 ZHANG Jingliang;GUO Shougang(Department of Neurology,Shandong Provincial Hospital Affiliated to Shandong First medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院神经内科,山东济南250021

出　　处：《医学影像学杂志》2024年第11期1-5,共5页Journal of Medical Imaging

基　　金：国家自然科学基金资助项目(编号:82371351)。

摘　　要：目的探讨抗γ-氨基丁酸B受体(GABA_(B)R)抗体脑炎的临床及影像学特点。方法选取我院收治的经临床证实的13例抗GABA_(B)R抗体脑炎患者的资料,对其临床表现、实验室检查、脑电图、MRI及^(18)F-FDG PET/CT影像学特点等资料进行回顾性分析。结果1)临床表现:13例患者均出现癫痫发作,其中6例表现为记忆力减退和精神行为异常,1例出现恶心呕吐、肢体麻木无力,1例出现行走不稳;2)实验室检查:13例患者中12例血清和脑脊液抗GABA_(B)R抗体均为阳性,其中2例合并SOX-1、Hu抗体,1例合并Hu、Ri、Recoverin抗体。8例脑脊液细胞数升高,6例蛋白增高。10例患者脑电图异常,其中3例记录到癫痫样放电;3)影像学检查:13例患者中6例MRI表现异常,可见T_(2)WI、T_(2)FLAIR异常信号,累及颞叶、海马、额叶、延髓、岛叶、枕叶、基底节区,均未见明显强化。5例患者行^(18)F-FDG PET/CT检查,异常者4例,均表现为葡萄糖代谢减低。2例患者MRI及^(18)F-FDG PET/CT均表现异常,且^(18)F-FDG PET/CT显示病变范围较MRI更为广泛。结论抗GABA_(B)R抗体脑炎脑电图主要表现为背景节律异常及慢波活动增强。MRI多见单侧或双侧颞叶、海马病变,PET/CT在发现病灶方面可能优于MRI,有助于疾病早期诊断。Objective To investigate the clinical and imaging characteristics of anti-gamma-aminobutyric acid B receptor(GABA_(B)R)antibody encephalitis.Methods Data from 13 clinically confirmed cases of anti-GABA_(B)R antibody encephalitis treated at our hospital were retrospectively analyzed,including clinical manifestations,laboratory findings,electroencephalogram(EEG)results,and imaging features from Magnetic resonance imaging(MRI)and Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography(^(18)F-FDG PET/CT).Results 1)Clinical manifestations:all 13 patients experienced seizures,with 6 showing memory decline and psychiatric or behavioral abnormalities.One patient exhibited nausea,vomiting,limb numbness and weakness,while another presented with unsteady gait;2)Laboratory findings:anti-GABA_(B)R antibodies were positive in both serum and CSF in 12 patients.Two patients were positive for SOX-1 and Hu antibodies,and one case was positive for Hu,Ri,and Recoverin antibodies.Elevated CSF cell counts were noted in 8 cases,and increased protein levels were found in 6 cases.Abnormal EEG findings were observed in 10 patients,with epileptic discharges recorded in 3 cases;and 3)Imaging findings:Among the 13 patients,6 exhibited abnormal findings on cranial magnetic resonance imaging(MRI),including abnormal signals on T_(2)-weighted imaging(T_(2)WI)and fluid-attenuated inversion recovery(FLAIR)sequences,involving the temporal lobe,hippocampus,frontal lobe,medulla oblongata,insula,occipital lobe,and basal ganglia,with no significant enhancement observed.Five patients underwent ^(18)F-FDG PET/CT scans,and abnormalities were detected in four of them,all showing reduced glucose metabolism.Two patients had abnormalities on both MRI and ^(18)F-FDG PET/CT,with the latter demonstrating a more extensive range of lesions compared to MRI.Conclusion The EEG of anti-GABA_(B)R antibody encephalitis mainly shows abnormal background rhythm and increased slow-wave activity.MRI often reveals unilateral or bilateral lesions in tem

关 键 词：抗γ-氨基丁酸B受体抗体脑炎 自身免疫性脑炎 磁共振成像 正电子发射断层显像 

分 类 号：R512.3[医药卫生—内科学] R445[医药卫生—临床医学]