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抗N-甲基-D-天冬氨酸受体脑炎患者的脑脊液与血清抗NMDA受体抗体特征分析

Profiles of cerebrospinal fluid and serum anti-NMDAR antibodies in patients with anti-N-methyl-D-aspartate receptor encephalitis
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摘要 目的:探讨抗NMDA受体脑炎患者脑脊液与血清抗NMDA受体抗体动态变化规律。方法:回顾性分析2017年8月至2019年1月广东三九脑科医院收治的50例抗NMDA受体脑炎患者的脑脊液与血清抗NMDA受体抗体资料。结果:50例患者中脑脊液、血清抗NMDA受体抗体定量检出阳性率分别为70%、64%,95%以上呈阳性时间分别为11.78~33.83d、12.25~35.11d,脑脊液、血清抗体阳性出现时间比较,差异无统计学意义(P=0.91)。30例均行脑脊液及血清抗NMDAR抗体检测,其中9例(30%)脑脊液与血清滴度匹配,4例(13%)脑脊液滴度高,17例(57%)血清抗体滴度高。12例跟踪随访患者中,7例(14%)复查脑脊液或血清抗NMDA受体抗体转阴,另外5例血清或脑脊液抗NMDA受体抗体滴度动态观察在逐渐转弱。结论:脑脊液、血清中抗NMDA受体抗体检查对抗NMDA受体脑炎的诊断具有重要价值,血清抗体滴度的检查较脑脊液抗体滴度更敏感。脑脊液抗NMDAR抗体滴度下降速度较血清快,血清抗NMDAR抗体滴度持续时间较脑脊液长,脑脊液抗NMDA受体特异常性更高,对诊断及判断预后更有帮助。 Objective:To investigate the serial changes in level of cerebrospinal fluid(CSF)and serum anti-N-methyl-D-aspartate receptor(anti-NMDAR)antibodies in patients with anti-NMDAR encephalitis.Methods:The CSF and serum anti-NMDAR antibody levels from 50 patients with anti-NMDAR encephalitis admitted to Guangdong Sanjiu Brain Hospital between August 2017 and January 2019 were reviewed.Results:Quantitative tests showed that the CSF and serum anti-NMDAR antibodies were positive in 70%and 64%,respectively,of the 50 patients.In more than 90%of the patients,the positivity of CSF and serum anti-NMDAR antibodies occurred within the time ranges of 11.78~33.83 d and 12.25~35.11 d,respectively.There was no statistically significant difference in the time of positivity between CSF and serum antibodies(P=0.91).In 30 patients tested concomitantly for CSF and serum anti-NMDAR antibodies,9(30%)had matched titers of CSF and serum antibodies,4(13%)had higher CSF titers and 17(57%)had higher serum titers.Twelve patients were followed up,of whom,7(14%)had CSF or serum conversion,and the other 5 showed serial decline in serum or CSF anti-NMDAR antibody titers.Conclusion:Detection of CSF and serum anti-NMDAR antibodies is of great importance in diagnosing anti-NMDAR encephalitis.The testing for antibody titer is more sensitive with serum compared with CSF.The anti-NMDAR antibody titer declines quicker in CSF and last longer in serum.However,testing for CSF titers offers more specificity,and is even more valuable diagnosis and prognostic evaluation.
作者 钟水生 胡琼力 李志刚 杨慧 包泽岩 廖硕希 唐晓梅 廖华印 曾昭龙 吴明秀 向姣 Zhong Shuisheng;Hu Qiongli;Li Zhigang;Yang Hui;Bao Zeyan;Liao Shuoxi;Tang Xiaomei;Liao Huayin;Zeng Zhaolong;Wu Mingxiu;Xiang Jiao(Department of Neurology,Guangdong Sanjiu Brain Hospital,Guangzhou 510510,China)
出处 《广州医科大学学报》 2019年第3期30-32,共3页 Academic Journal of Guangzhou Medical University
基金 广东省医学科学技术研究基金项目(A2017245).
关键词 脑炎 抗NMDA受体 抗体滴度 Encephalitis anti-NMDA receptor antibody titer
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