Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Peripher Nerv Syst. 2018 Dec;23(4):227-234. doi: 10.1111/jns.12285. Epub 2018 Sep 12.
Antibodies to the ganglioside GD1b have been reported in various forms of immune-mediated neuropathy, but their clinical relevance for diagnosis and prognosis is unknown. We investigated the prevalence of anti-GD1b antibodies in acute and chronic immune-mediated neuropathies, and the clinical presentation and outcome in Guillain-Barré syndrome (GBS) and Miller Fisher-GBS overlap syndrome (MF-GBS). Anti-GD1b, anti-GM1 and anti-GQ1b antibodies were tested in serum of patients with GBS (N = 165), Miller Fisher syndrome (N = 10), MF-GBS (N = 28), monoclonal gammopathy of unknown significance neuropathy (MGUS; N = 101), chronic inflammatory demyelinating polyneuropathy (N = 29), paraneoplastic syndrome with anti-Hu-associated neuropathy (PNS; N = 11), other auto-immune diseases (AID; N = 60), and healthy controls (HC; N = 60). All samples were tested by enzyme-linked immunosorbent assay according to the Inflammatory Neuropathy Cause and Treatment protocol. IgM anti-GD1b antibodies were found in GBS (N = 4; 2.4%), MGUS (N = 3; 3.0%), and PNS patients (N = 1; 9.1%). IgG anti-GD1b antibodies were found in GBS (N = 20; 12.1%) and MF-GBS (N = 4; 14.3%) patients, but not in the AID and HC group. In the combined group of MF-GBS and GBS patients ((MF-)GBS), 14/36 (38.9%) patients with IgG anti-GD1b antibodies also had IgG anti-GM1 antibodies, and IgG anti-GD1b and IgG anti-GQ1b antibodies were found in 3/29 (10.3%) patients. Patients with (MF-)GBS and anti-GD1b without anti-GM1 antibodies did not differ regarding sensory disturbances or disease severity but recovered faster regarding the ability to walk independently compared with patients without anti-GD1b antibodies (P = 0.031) and with patients with both anti-GD1b and anti-GM1 antibodies (P = 0.034). In conclusion, testing for anti-GD1b antibodies may identify a specific group of immune-mediated neuropathies and (MF-)GBS patients with only anti-GD1b antibodies tend to recover faster.
抗神经节苷脂 GD1b 抗体已在各种免疫介导性神经病中被报道，但它们在诊断和预后方面的临床意义尚不清楚。我们研究了急性和慢性免疫介导性神经病中抗-GD1b 抗体的流行情况，以及格林-巴利综合征（GBS）和米勒-费舍尔-GBS 重叠综合征（MF-GBS）中的临床表现和结局。我们检测了 165 例 GBS 患者（GBS）、10 例米勒-费舍尔综合征（Miller Fisher syndrome）患者、28 例 MF-GBS 患者、101 例意义未明的单克隆丙种球蛋白血症相关性神经病（monoclonal gammopathy of unknown significance neuropathy，MGUS）患者、29 例慢性炎症性脱髓鞘性多发性神经病（chronic inflammatory demyelinating polyneuropathy，CIDP）患者、11 例副肿瘤综合征伴抗 Hu 相关性神经病（paraneoplastic syndrome with anti-Hu-associated neuropathy，PNS）患者、60 例其他自身免疫性疾病（other auto-immune diseases，AID）患者和 60 例健康对照者（healthy controls，HC）血清中的抗-GD1b、抗-GM1 和抗-GQ1b 抗体。所有样本均根据《炎性神经病病因和治疗方案》进行酶联免疫吸附试验检测。在 GBS 患者（n=4；2.4%）、MGUS 患者（n=3；3.0%）和 PNS 患者（n=1；9.1%）中发现 IgM 抗-GD1b 抗体。在 GBS 患者（n=20；12.1%）和 MF-GBS 患者（n=4；14.3%）中发现 IgG 抗-GD1b 抗体，但在 AID 和 HC 组中未发现。在 MF-GBS 和 GBS 患者的合并组（(MF-)GBS）中，14/36（38.9%）IgG 抗-GD1b 抗体阳性患者也存在 IgG 抗-GM1 抗体，29 例患者（10.3%）中存在 IgG 抗-GD1b 和 IgG 抗-GQ1b 抗体。在（MF-)GBS 患者中，无抗-GM1 抗体而有抗-GD1b 抗体的患者在感觉障碍或疾病严重程度方面无差异，但与无抗-GD1b 抗体的患者（P=0.031）和同时具有抗-GD1b 和抗-GM1 抗体的患者（P=0.034）相比，独立行走的恢复速度更快。总之，检测抗-GD1b 抗体可能会识别出一组特定的免疫介导性神经病和（MF-)GBS 患者，而仅存在抗-GD1b 抗体的患者往往恢复更快。
