Tzang Ruu-Fen, Chang Chuan-Hsin, Chang Yue-Cune, Lane Hsien-Yuan
Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.
Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
Front Psychiatry. 2019 Jun 21;10:440. doi: 10.3389/fpsyt.2019.00440. eCollection 2019.
The purpose of this review is to correlate autism with autoimmune dysfunction in the absence of an explanation for the etiology of autism spectrum disorder. The anti-N-methyl-D-aspartate receptor (anti-NMDAR) autoantibody is a typical synaptic protein that can bind to synaptic NMDA glutamate receptors, leading to dysfunctional glutamate neurotransmission in the brain that manifests as psychiatric symptoms (psychosis, hallucinations, and personality changes). Detection of autoantibodies, cytokines, decreased lymphocytes, serum immunoglobulin level imbalance, T-cell mediated immune profile, maternal infection history, and children's infection history can all be vital biological markers of autoimmune autism. Diagnosing autoimmune encephalitis sooner can increase the effectiveness of curative treatments-such as immune therapy or immune modulatory therapy-that may prevent the long-term consequence of being misdiagnosed with autism spectrum disorder. Glutamate therapy primarily normalizes glutamate neurotransmission and can be a new add-on intervention alongside antipsychotics for treating autoimmune autism.
本综述的目的是在缺乏对自闭症谱系障碍病因解释的情况下,将自闭症与自身免疫功能障碍联系起来。抗N-甲基-D-天冬氨酸受体(抗NMDAR)自身抗体是一种典型的突触蛋白,可与突触NMDA谷氨酸受体结合,导致大脑中谷氨酸神经传递功能失调,表现为精神症状(精神病、幻觉和人格改变)。自身抗体、细胞因子、淋巴细胞减少、血清免疫球蛋白水平失衡、T细胞介导的免疫谱、母亲感染史和儿童感染史的检测都可能是自身免疫性自闭症的重要生物学标志物。尽早诊断自身免疫性脑炎可以提高治疗的有效性,如免疫疗法或免疫调节疗法,这可能会防止被误诊为自闭症谱系障碍的长期后果。谷氨酸疗法主要使谷氨酸神经传递正常化,并且可以作为一种新的辅助干预措施,与抗精神病药物一起用于治疗自身免疫性自闭症。