Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
J Clin Virol. 2018 Jun;103:75-80. doi: 10.1016/j.jcv.2018.04.007. Epub 2018 Apr 10.
Herpes simplex encephalitis (HSE) is a devastating disease, often leaving patients with severe disabilities. It has been shown that IgG anti-N-methyl-d-aspartate receptor (NMDAR) antibodies appear in approximately 25% of HSE patients and could be associated with impaired recovery of cognitive performance.
To characterize the prevalence of IgM and IgA anti-NMDAR antibodies in HSE patients, in relation to subsequent development of IgG anti-NMDAR and correlation to cognitive performance.
A total of 48 subjects were included from a previously described cohort of patients with HSE verified by HSV-1 PCR. Cerebrospinal fluid (CSF) and serum samples drawn close to onset of disease, after 14-21 days of iv aciclovir treatment and after 90 days of follow-up, were analyzed for the presence of IgM and IgA anti-NMDAR, and related to IgG anti-NMDAR. Antibody levels were correlated to the recovery of cognitive performance, as estimated by the Mattis Dementia Rating Scale (MDRS), for a total of 24 months.
In total, 27 of 48 (56%) study subjects were anti-NMDAR positive, defined as the presence of IgG (12/48, 25%), IgM (14/48, 29%) or IgA (13/48, 27%) antibodies in CSF and/or serum. IgM or IgA anti-NMDAR did not predict subsequent IgG autoimmunization and did not correlate to cognitive outcome. IgG anti-NMDAR serostatus, but not antibody titers, correlated to impaired recovery of cognitive performance.
A majority of HSE patients develop IgG, IgM or IgA anti-NMDAR antibodies. However, the predictive value and clinical relevance of non-IgG isotypes remains to be shown in this setting.
单纯疱疹脑炎（HSE）是一种破坏性疾病，常导致患者严重残疾。已经表明，大约 25%的 HSE 患者会出现 IgG 抗 N-甲基-D-天冬氨酸受体（NMDAR）抗体，并且可能与认知功能恢复受损有关。
描述 HSE 患者中 IgM 和 IgA 抗 NMDAR 抗体的流行情况，以及与 IgG 抗 NMDAR 的后续发展和与认知表现的相关性。
总共纳入了 48 名来自先前描述的 HSV-1 PCR 验证的 HSE 患者队列的患者。在疾病发作后 14-21 天接受静脉阿昔洛韦治疗后，以及在 90 天的随访期间，采集脑脊液（CSF）和血清样本，以分析存在 IgM 和 IgA 抗 NMDAR，并与 IgG 抗 NMDAR 相关。抗体水平与认知表现的恢复相关，用 Mattis 痴呆评定量表（MDRS）进行评估，总共持续 24 个月。
总共 48 名研究对象中有 27 名（56%）为抗 NMDAR 阳性，定义为 CSF 和/或血清中存在 IgG（12/48，25%）、IgM（14/48，29%）或 IgA（13/48，27%）抗体。IgM 或 IgA 抗 NMDAR 不能预测随后的 IgG 自身免疫，也与认知结果无关。只有 IgG 抗 NMDAR 血清状态，而不是抗体滴度，与认知功能恢复受损相关。
大多数 HSE 患者会产生 IgG、IgM 或 IgA 抗 NMDAR 抗体。然而，在这种情况下，非 IgG 同种型的预测价值和临床相关性仍有待证明。
