Department of Obstetrics and Gynecology, Division of Reproductive Biology, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.
Autoimmun Rev. 2012 Oct;11(12):863-72. doi: 10.1016/j.autrev.2012.03.001. Epub 2012 Mar 11.
Anti-NMDAR encephalitis is a newly characterized syndrome with a progressive, predictable clinical course and the possibility of effective treatment. Accurate and timely diagnosis is critical to selection and implementation of treatments, and optimal patient outcomes. Outcomes are improved with early diagnosis via indirect immunofluorescence or cell-based assays, and the rapid and appropriate administration of immunosuppressant and anti-psychotic therapies. Three possible scenarios accounting for the immunopathogenesis of anti-NMDAR encephalitis are presented, with the most probable one being that of paraneoplastic autoimmunity. Future efforts in this disorder should focus on elucidating the mechanisms that contribute to initiation of this antibody response, as well as exploring the role of tumors, infectious triggers and immune-reactivation. Finally, accessible tools need to be developed that allow for reliable identification of specific antibody markers against synaptic proteins.
抗 NMDAR 脑炎是一种新确定的综合征，具有进行性、可预测的临床过程和有效的治疗可能性。准确及时的诊断对于选择和实施治疗以及获得最佳患者结局至关重要。通过间接免疫荧光或基于细胞的检测，早期诊断可改善结局，并且快速、适当地给予免疫抑制剂和抗精神病治疗也可改善结局。抗 NMDAR 脑炎的免疫发病机制有三种可能的情况，最可能的是副肿瘤自身免疫。未来在这种疾病上的努力应集中于阐明导致这种抗体反应的机制，以及探索肿瘤、感染触发和免疫激活的作用。最后，需要开发易于使用的工具，以可靠地鉴定针对突触蛋白的特异性抗体标志物。
