泰国脑炎综合征的自身免疫性病因：103 例患者的前瞻性研究。
Autoimmune causes of encephalitis syndrome in Thailand: prospective study of 103 patients.
机构信息
Neuroscience Centre for Research and Development, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
出版信息
BMC Neurol. 2013 Oct 20;13:150. doi: 10.1186/1471-2377-13-150.
BACKGROUND
Data on encephalitis in Thailand have not been completely described. Etiologies remain largely unknown. We prospectively analyzed 103 Thai patients from 27 provinces for the causes of encephalitis using clinical, microbiological and neuroimaging indices; caseswithout a diagnosis were evaluated for autoimmune causes of encephalitis.
METHODS
Patients with encephalitis and/or myelitis were prospectively studied between October 2010 and August 2012. Cases associated with bacterial, rickettsial and mycobacterial diseases were excluded. Herpes viruses 1-6 and enteroviruses infection was diagnosed using PCR evaluation of CSF; dengue and JE viruses infection, by serology. The serum of test-negative patients was evaluated for the presence of autoantibodies.
RESULTS
103 patients were recruited. Fifty-three patients (52%) had no etiologies identified. Twenty-five patients (24%) were associated with infections. Immune encephalitis was found in 25 (24%); neuropsychiatric lupus erythematosus (4), demyelinating diseases (3), Behcet's disease (1) and the remaining had antibodies to NMDAR (5), ANNA-2 (6), Yo (2), AMPA (1), GABA (1), VGKC (1) and NMDA coexisting with ANNA-2 (1). Presenting symptoms in the autoimmune group included behavioral changes in 6/25 (versus 12/25 in infectious and 13/53 in unknown group) and as psychosis in 6/25 (versus 0/25 infectious and 2/53 unknown). Seizures were found in 6/25 autoimmune, 4/25 infectious and 19/53 unknown group. Two patients with anti-ANNA-2 and one anti-Yo had temporal lobe involvement by magnetic resonance imaging. Two immune encephalitis patients with antibodies to NMDAR and ANNA-2 had ovarian tumors.
CONCLUSIONS
Autoantibody-associated encephalitis should be considered in the differential diagnosis and management algorithm regardless of clinical and neuroimaging features.
背景
泰国脑炎的数据尚未完全描述。病因在很大程度上仍然未知。我们前瞻性地分析了来自 27 个省的 103 例泰国患者，使用临床、微生物学和神经影像学指标来确定脑炎的病因；对于没有诊断的病例，评估了自身免疫性脑炎的病因。
方法
2010 年 10 月至 2012 年 8 月期间，前瞻性研究了患有脑炎和/或脊髓炎的患者。排除了与细菌、立克次体和分枝杆菌疾病相关的病例。使用 CSF 的 PCR 评估诊断 1-6 型疱疹病毒和肠道病毒感染；通过血清学检测登革热和日本脑炎病毒感染。对测试阴性患者的血清进行自身抗体检测。
结果
共纳入 103 例患者。53 例（52%）未确定病因。25 例（24%）与感染相关。免疫性脑炎 25 例（24%）；神经精神狼疮（4 例）、脱髓鞘疾病（3 例）、贝切特病（1 例），其余 5 例抗 NMDAR 抗体阳性，抗 ANNA-2 抗体阳性 6 例，抗 Yo 抗体阳性 2 例，抗 AMPA 抗体阳性 1 例，抗 GABA 抗体阳性 1 例，抗 VGKC 抗体阳性 1 例，抗 NMDA 抗体阳性同时抗 ANNA-2 抗体阳性 1 例。自身免疫组的首发症状包括行为改变 6/25 例（感染组 12/25 例，未知组 13/53 例）和精神病 6/25 例（感染组 0/25 例，未知组 2/53 例）。癫痫发作见于自身免疫组 6/25 例，感染组 4/25 例，未知组 19/53 例。2 例抗 ANNA-2 和 1 例抗 Yo 的自身免疫患者磁共振成像显示颞叶受累。2 例抗 NMDAR 和抗 ANNA-2 的免疫性脑炎患者有卵巢肿瘤。
结论
无论临床和神经影像学特征如何，自身抗体相关脑炎均应考虑纳入鉴别诊断和治疗方案。
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