自身免疫性脑炎患儿的细胞免疫及体液免疫功能特征研究
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摘要
目的探讨自身免疫性脑炎(AE)患儿的细胞免疫及体液免疫功能,以证实该病免疫特征。方法选取徐州市儿童医院神经内科收治的84例AE患儿作为研究组,另选取80例健康幼儿作为对照组。采集两组的空腹静脉血,使用全自动生化分析仪进行血清免疫球蛋白(IgA、IgG、IgM)水平检测,使用流式细胞仪测定血清CD3、CD4、CD8、CD54水平。所有入组对象还要采集血液标本的上清液测定抗谷氨酸脱羧酶(GAD)抗体与抗N-甲基-M-天冬氨酸受体(NMDAR)抗体水平,研究组患儿还需采集脑脊液测定抗GAD抗体及抗NMDAR抗体水平。对比、分析两组的各项指标检测结果。结果研究组患儿的血清及脑脊液抗GAD抗体、抗NMDAR抗体检测结果均为阴性,对照组儿童的血清抗GAD抗体、抗NMDAR抗体检测结果也为阴性。研究组的IgM、IgA、IgG水平均显著高于对照组(P<0.05)。研究组的CD3、CD4水平均显著低于对照组(P<0.05);两组的CD8、CD54水平接近(P>0.05)。结论 AE患儿普遍存在细胞免疫及体液免疫功能紊乱,抗GAD抗体与抗NMDAR抗体并非AE致病的主要因素,临床观察患儿细胞及体液免疫指标的变化,可为AE的诊断与治疗提供一定的参考依据。
Objective To investigate the cellular immunity and humoral immune function of children with autoimmune encephalitis(AE).Method Selected 84 children with autoimmune encephalitis as study group and 80 healthy children as control group.Collected the fasting venous blood from both groups,then detected the serum immunoglobulin(IgA,IgG,IgM)levels by an automatic biochemical analyzer and measured the serum CD3,CD4,CD8,and CD54 levels by flow cytometry.All subjects were also enrolled in the supernatant of blood samples to determine anti glutamic acid decarboxylase(GAD)antibody and anti N-methyl-M-aspartate receptor(NMDAR)antibody levels.The study group also needed to collect cerebrospinal fluid to measure anti-GAD antibody and antiNMDAR antibody levels.Compared and analyzed the test results of each group.Results Serum and cerebrospinal fluid anti-GAD antibodies and anti-N MDAR antibodies were negative in the study group.Serum anti-GAD antibodies and anti-NMDAR antibodies were also negative in the control group.The IgM,IgA,and IgG levels in the study group were significantly higher than those in the control group(P<0.05).The levels of CD3 and CD4 in the study group were significantly lower than those in the control group(P<0.05).The levels of CD8 and CD54 in the two groups were similar,and the difference was not statistically significant(P>0.05).Conclusion Cellular immunity and humoral immune dysfunction are common in children with autoimmune encephalitis.Anti-GAD antibody and anti-NMDAR antibody are not necessary factors for autoimmune encephalitis.Clinical observation of changes in cellular and humoral immune indexes in children,it can provide a certain reference for clinical diagnosis of autoimmune encephalitis.
Objective To investigate the cellular immunity and humoral immune function of children with autoimmune encephalitis(AE).Method Selected 84 children with autoimmune encephalitis as study group and 80 healthy children as control group.Collected the fasting venous blood from both groups,then detected the serum immunoglobulin(IgA,IgG,IgM)levels by an automatic biochemical analyzer and measured the serum CD3,CD4,CD8,and CD54 levels by flow cytometry.All subjects were also enrolled in the supernatant of blood samples to determine anti glutamic acid decarboxylase(GAD)antibody and anti N-methyl-M-aspartate receptor(NMDAR)antibody levels.The study group also needed to collect cerebrospinal fluid to measure anti-GAD antibody and antiNMDAR antibody levels.Compared and analyzed the test results of each group.Results Serum and cerebrospinal fluid anti-GAD antibodies and anti-N MDAR antibodies were negative in the study group.Serum anti-GAD antibodies and anti-NMDAR antibodies were also negative in the control group.The IgM,IgA,and IgG levels in the study group were significantly higher than those in the control group(P<0.05).The levels of CD3 and CD4 in the study group were significantly lower than those in the control group(P<0.05).The levels of CD8 and CD54 in the two groups were similar,and the difference was not statistically significant(P>0.05).Conclusion Cellular immunity and humoral immune dysfunction are common in children with autoimmune encephalitis.Anti-GAD antibody and anti-NMDAR antibody are not necessary factors for autoimmune encephalitis.Clinical observation of changes in cellular and humoral immune indexes in children,it can provide a certain reference for clinical diagnosis of autoimmune encephalitis.
引文
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[18]Anda T,Foto Y,Mann K,et al.Paraneoplastic autoimmune encephalitis associated with pleomorphic lung carcinoma:An autopsy case report[J].Neuropathology,2018,doi:10.1111.
[19]Schankin CJ,K?stele F,Gerdes LA,et al.New-onset headache in patients with autoimmune encephalitis is associated with antiNMDA-receptor antibodies[J].Headache,2016,56(6):995-1003.
[20]Gough JL,Coebergh J,Chandra B,et al.Electroconvulsive therapy and/or plasmapheresis in autoimmune encephalitis?[J].World J Clin Cases,2016,4(8):223-228.
[2]Li L,Sun L,Du R,et al.Application of the 2016 diagnostic approach for autoimmune encephalitis from Lancet Neurology to Chinese patients[J].BMC Neurol,2017,17(1):195.
[3]刘婷婷,杜芳,孙元杰,等.自身免疫性脑炎患者外周血Tfh细胞的检测及其临床意义[J].中国免疫学杂志,2017,33(11):1678-1681.
[4]陈向军,邓波.自身免疫性脑炎的诊断标准及其临床指导意义[J].中国临床神经科学,2016,24(9):336-340.
[5]Dubey D,Pittock SJ,Kelly CR,et al.Autoimmune encephalitis epidemiology and a comparison to infections encephalitis[J].Ann Neurol,2018,83(1):166-177.
[6]Harutyunyan Ga,Hauer L,Dünser MW,et al.Autoimmune encephalitis at the neurological intensive care unit:etiologies,reasons for admission and survival[J].Neurocriti Care,2017,27(1):82-89.
[7]Ando T,Goto Y,Mano K,et al.Paraneoplastic autoimmune encephalitis associated with plemorphic lung carcinoma:An autopsycase report[J].Neuropathology,2018,doi:10.1111.
[8]Constantinescu R,Krysl D,Bergquist F,et al.Cerebrospinal fluid markers of neuronal and glial cell damage to monitor disease activity and predict long-term outcome in patients with autoimmune encephalitis[J].Eur J Neurol,2016,23(4):796-806.
[9]Schankin C,Kastelc F,Gerdes LA,et al New-onset headache in patients with autoimmune encephalitis is associated with antiNMDA-receptor antibodies[J].Headache,2016,56(6):995-1003.
[10]Cyril AC,Nairss,Mathai A,et al.Autoimmune encephalitis:clinical diagnosis versus antibody confirmation[J].Ann Indian Academy Neurol,2015,18(4):408-411.
[11]Haital R,Huiqin L,TAO Q,et al.Autoimmune encephalitis associated with vitiligo?[J].J Neuroimmunol,2017,310:14-16.
[12]Steriade C,Moosu ANN,Hantus S,et al.Electroclinical features of seizures associated with autoimmune encephalitis[J].Seizure,2018,60:198-204.
[13]Caputo D,lorio R,Vigevano F,et al.Febrile infection-related epilepsy syndrome(FIRES)with super-refractory status epilepticus revealing autoimmune encephalitis due to GABAA R antibodies[J].Eur J Paediatr Neurol,2018,22(1):182-185.
[14]Randell RL,Adams AV,Vanmater H.Tocilizumab in refractory autoimmune encephalitis:A series of pediatric cases[J].Pediatr Neurol,2018,86:66-68.
[15]Albert DV,Pluto CP,Weber A,et al.Utility of neurodiagnostic studies in the diagnosis of autoimmune encephalitis in children[J].Pediatr Neurol,2016,55:37-45.
[16]Brenton JN,Goodkin HP.Antibody-mediated autoimmune encephalitis in childhood[J].Pediatr Neurol,2016,60:13-23.
[17]Holle JF,Jessen F,Kuhn J.Cliniscal Phenomenolog of autoimmune encephalitis[J].Fortschr Neurol Psychiatr,2016,84(5):271-280.
[18]Anda T,Foto Y,Mann K,et al.Paraneoplastic autoimmune encephalitis associated with pleomorphic lung carcinoma:An autopsy case report[J].Neuropathology,2018,doi:10.1111.
[19]Schankin CJ,K?stele F,Gerdes LA,et al.New-onset headache in patients with autoimmune encephalitis is associated with antiNMDA-receptor antibodies[J].Headache,2016,56(6):995-1003.
[20]Gough JL,Coebergh J,Chandra B,et al.Electroconvulsive therapy and/or plasmapheresis in autoimmune encephalitis?[J].World J Clin Cases,2016,4(8):223-228.