Church A J, Dale R C, Lees A J, Giovannoni G, Robertson M M
Neuroinflammation Department, Institute of Neurology, Queen Square, London, UK.
J Neurol Neurosurg Psychiatry. 2003 May;74(5):602-7. doi: 10.1136/jnnp.74.5.602.
The classical neurological disorder after group A beta haemolytic streptococcal infection is Sydenham's chorea. Recently a tic disorder occurring after group A streptococcal infection has been described and termed PANDAS (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection). It is proposed that antibodies induced after group A streptococcal infection react with basal ganglia neurones in Sydenham's chorea and PANDAS. Anti-basal ganglia antibodies (ABGA) are present in most cases of acute Sydenham's chorea, but rarely in controls.
To investigate the hypothesis that Tourette's syndrome may be associated with group A streptococcal infection and ABGA.
100 patients with Tourette's syndrome (DSM-IV-TR) were enrolled in a cross sectional study. Children with neurological disease (n = 50) and recent uncomplicated streptococcal infection (n = 40), adults with neurological disease (n = 50), and healthy adults (n = 50) were studied as controls. Recent group A streptococcal infection was defined using antistreptolysin O titre (ASOT). ABGA were detected using western immunoblotting and indirect immunofluorescence.
ASOT was raised in 64% of children with Tourette's syndrome compared with 15% of paediatric neurological disease controls (p < 0.0001), and in 68% of adults with Tourette's syndrome compared with 12% of adult neurological controls and 8% of adult healthy controls (p < 0.05). Western immunoblotting showed positive binding in 20% of children and 27% of adults with Tourette's syndrome, compared with 2-4% of control groups (p < 0.05). The most common basal ganglia binding was to a 60 kDa antigen, similar to the proposed antigen in Sydenham's chorea. Indirect immunofluorescence revealed autoantibody binding to basal ganglia neurones. Serological evidence of recent group A streptococcal infection, assessed by a raised ASOT, was detected in 91% (21/23) of Tourette's syndrome patients with positive ABGA compared with 57% (44/77) with negative ABGA (p < 0.01).
The results support a role of group A streptococcal infection and basal ganglia autoimmunity in a subgroup of patients with Tourette's syndrome and suggest a pathogenic similarity between Sydenham's chorea and some patients with Tourette's syndrome.
A 组β溶血性链球菌感染后的经典神经障碍是 Sydenham 舞蹈病。最近，一种在 A 组链球菌感染后出现的抽动障碍被描述并命名为 PANDAS（与链球菌感染相关的儿科自身免疫性神经精神障碍）。有人提出，A 组链球菌感染后诱导产生的抗体与 Sydenham 舞蹈病和 PANDAS 中的基底节神经元发生反应。抗基底节抗体（ABGA）在大多数急性 Sydenham 舞蹈病病例中存在，但在对照组中很少见。
研究抽动秽语综合征可能与 A 组链球菌感染和 ABGA 相关的假说。
100 例抽动秽语综合征（DSM-IV-TR）患者纳入一项横断面研究。将患有神经疾病的儿童（n = 50）和近期无并发症的链球菌感染儿童（n = 40）、患有神经疾病的成人（n = 50）以及健康成人（n = 50）作为对照进行研究。使用抗链球菌溶血素 O 滴度（ASOT）来定义近期 A 组链球菌感染。采用蛋白质免疫印迹法和间接免疫荧光法检测 ABGA。
与 15%的儿科神经疾病对照组相比，64%的抽动秽语综合征儿童 ASOT 升高（p < 0.0001）；与 12%的成人神经疾病对照组和 8%的成人健康对照组相比，68%的抽动秽语综合征成人 ASOT 升高（p < 0.05）。蛋白质免疫印迹法显示，20%的抽动秽语综合征儿童和 27%的成人有阳性结合，而对照组为 2 - 4%（p < 0.05）。最常见的基底节结合是与一种 60 kDa 的抗原，类似于 Sydenham 舞蹈病中提出的抗原。间接免疫荧光显示自身抗体与基底节神经元结合。在 ABGA 阳性的抽动秽语综合征患者中，91%（21/23）通过升高的 ASOT 检测到近期 A 组链球菌感染的血清学证据，而 ABGA 阴性的患者中这一比例为 57%（44/77）（p < 0.01）。
结果支持 A 组链球菌感染和基底节自身免疫在一部分抽动秽语综合征患者中起作用，并提示 Sydenham 舞蹈病与部分抽动秽语综合征患者之间存在致病相似性。
