Liu Zifan, Huang Qingmei, Li Huijuan, Qiu Wei, Chen Baikeng, Luo Jie, Yang Huacai, Liu Tianni, Liu Si, Xu Huiming, Long Youming, Gao Cong
Department of Neurology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Neuroimmunomodulation. 2018;25(2):68-72. doi: 10.1159/000490530. Epub 2018 Jul 26.
The aim of this study was to evaluate the positive rate of serum glutamic acid decarboxylase (GAD) autoantibody in patients with myelitis and to describe the clinical findings in patients with positive GAD antibody.
Serum samples were collected from 390 patients with myelitis, including 210 patients positive for aquaporin 4 (AQP4) antibody and 180 patients negative for AQP4. GAD65 antibody was measured by an indirect immunofluorescence assay.
Only 1 serum and cerebral spinal fluid sample from 390 patients (0.26%) was positive for anti-GAD antibodies. The patient was a female with relapsing myelitis and a thymic mass. Thymic resection was undertaken, and pathological examination revealed a benign thymic cyst. Extensive infiltration of lymphocytes positive for CD3, CD4, CD8 and CD20 was found. Immunohistochemistry showed positive expression of GAD65 in the cyst.
Although serum GAD65 antibodies were present in a patient, it is not recommended to routinely screen for GAD65 antibodies in patients with myelitis because of their rare occurrence. However, screening for GAD65 antibodies should be considered in patients who have been diagnosed with cancer or a thymic abnormality.
本研究旨在评估脊髓炎患者血清谷氨酸脱羧酶（GAD）自身抗体的阳性率，并描述GAD抗体阳性患者的临床特征。
收集390例脊髓炎患者的血清样本，其中水通道蛋白4（AQP4）抗体阳性患者210例，AQP4抗体阴性患者180例。采用间接免疫荧光法检测GAD65抗体。
390例患者中仅1例血清和脑脊液样本抗GAD抗体呈阳性（0.26%）。该患者为女性，患有复发性脊髓炎和胸腺肿物。进行了胸腺切除术，病理检查显示为良性胸腺囊肿。发现CD3、CD4、CD8和CD20阳性淋巴细胞广泛浸润。免疫组化显示囊肿中GAD65呈阳性表达。
尽管有1例患者血清中存在GAD65抗体，但由于其发生率较低，不建议对脊髓炎患者常规筛查GAD65抗体。然而，对于已诊断为癌症或胸腺异常的患者，应考虑筛查GAD65抗体。
