Ma Jiannan, Han Wei, Jiang Li
Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing 400014, PR China.
Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing 400014, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, PR China; National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing 400014, PR China; Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400014, PR China.
Brain Dev. 2020 Feb;42(2):179-184. doi: 10.1016/j.braindev.2019.09.003. Epub 2019 Sep 25.
A hospital-based prospective study was performed to determine: 1) whether Japanese encephalitis (JE) normally triggers anti-N-methyl-d-aspartate receptor (NMDAR) immunoglobulin G (IgG) synthesis, especially in monophasic JE patients; and 2) the incidence of JE-induced anti-NMDAR encephalitis in pediatric patients with JE.
We detected the level of anti-NMDAR IgG in the serum and cerebral spinal fluid (CSF) of JE patients within one week of onset. If patients relapsed during the convalescence phase, we detected JE virus RNA in the CSF and anti-NMDAR IgG in both the serum and CSF. For patients who did not relapse during the convalescence phase, serum was collected and anti-NMDAR IgG was detected during the 30-60-day course of the disease.
We enrolled 65 JE patients, who were negative for anti-NMDAR IgG in the serum and CSF during the acute phase, of which 63 patients were successfully followed up. Five patients relapsed during the convalescence phase, for whom JE virus RNA in the CSF was negative and excluded latent JE reactivation. The distinctive symptoms of four younger patients were choreoathetosis, whereas the psychiatric and behavioral manifestations were the distinctive symptoms experienced by the teenager. Anti-NMDAR IgG in the CSF of three patients was positive and they were diagnosed with anti-NMDAR encephalitis. The other two patients were negative for anti-NMDAR IgG in both the serum and CSF. For the 58 patients who did not relapse during the convalescence phase, anti-NMDAR IgG was negative in the serum of all patients at 30-60 days during the course of the disease.
JE does not typically trigger anti-NMDAR IgG synthesis. Besides anti-NMDAR IgG, other unknown autoantibodies can also cause autoimmune encephalitis in the convalescence phase of JE. The incidence of JE-induced autoimmune encephalitis in pediatric patients with JE was 7.9%, and the incidence of JE-induced anti-NMDAR encephalitis was 4.7%.
开展一项基于医院的前瞻性研究，以确定：1）日本脑炎（JE）是否通常会引发抗N-甲基-D-天冬氨酸受体（NMDAR）免疫球蛋白G（IgG）合成，尤其是在单相JE患者中；以及2）JE患儿中JE诱发的抗NMDAR脑炎的发病率。
我们在发病一周内检测了JE患者血清和脑脊液（CSF）中的抗NMDAR IgG水平。如果患者在恢复期复发，我们检测了CSF中的JE病毒RNA以及血清和CSF中的抗NMDAR IgG。对于在恢复期未复发的患者，在疾病病程的30至60天期间采集血清并检测抗NMDAR IgG。
我们纳入了65例JE患者，其急性期血清和CSF中的抗NMDAR IgG均为阴性，其中63例患者得到成功随访。5例患者在恢复期复发，其CSF中的JE病毒RNA为阴性，排除了潜伏性JE再激活。4例较年轻患者的独特症状为舞蹈手足徐动症，而青少年患者的独特症状为精神和行为表现。3例患者CSF中的抗NMDAR IgG呈阳性，他们被诊断为抗NMDAR脑炎。另外2例患者血清和CSF中的抗NMDAR IgG均为阴性。对于58例在恢复期未复发的患者，在疾病病程的30至60天期间，所有患者血清中的抗NMDAR IgG均为阴性。
JE通常不会引发抗NMDAR IgG合成。除抗NMDAR IgG外，其他未知自身抗体也可在JE恢复期引起自身免疫性脑炎。JE患儿中JE诱发的自身免疫性脑炎的发病率为7.9%，JE诱发的抗NMDAR脑炎的发病率为4.7%。
