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拉丁美洲的自身免疫性脑炎:一项批判性综述。

Autoimmune Encephalitis in Latin America: A Critical Review.

作者信息

Vasconcelos Gabriel de Albuquerque, Barreira Rodrigo Montenegro, Antoniollo Karmelita Emanuelle Nogueira Torres, Pinheiro Alina Maria Nuñez, Maia Cíntia Fernandes Rodrigues, Alves Danyela Martins Bezerra Soares, Nóbrega Paulo Ribeiro, Braga-Neto Pedro

机构信息

Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil.

Division of Neurology, Department of Clinical Medicine, Fortaleza, Brazil.

出版信息

Front Neurol. 2021 Jan 21;11:606350. doi: 10.3389/fneur.2020.606350. eCollection 2020.

Abstract

Autoimmune encephalitis is an increasingly recognized cause of encephalitis. The majority of case series report patients residing in developed countries in the northern hemisphere. The epidemiologic features of autoimmune encephalitis in Latin America are still unclear. The aim of the study was to perform a review of the clinical presentation of autoimmune encephalitis in Latin America and compare to world literature. References were identified by an in-depth literature search and selected on the basis of relevance to the topic and authors' judgment. We selected clinical studies and case reports published from 2007 to July, 2020 including patients from Latin American countries. Of the 379 patients included, the majority were cases of anti-NMDA receptor encephalitis (93.14%), followed by anti-VGKC-complex encephalitis ( = 17; 4.48%), anti-GAD encephalitis ( = 9; 2.37%), anti-AMPA receptor encephalitis ( = 1; 0.26%), anti-GABA receptor encephalitis ( = 1; 0. 26%), anti-mGluR5 encephalitis ( = 1; 0. 26%), and anti-mGluR1 encephalitis ( = 1; 0. 26%). Reported cases of Anti-NMDA encephalitis in Latin-America had a very slight female predominance, lower prevalence of associated tumors and a lower incidence of extreme delta brush on electroencephalogram. Autoimmune encephalitis is possibly underdiagnosed in underdeveloped countries. Its outcome after treatment, however, appears to be similarly favorable in Latin American patients as has been reported in developed countries based on available case reports and case series. Regional specificities in the manifestation of autoimmune encephalitis could be related to epidemiologic factors, such as the presence of different triggers and different genetic and immunologic background, that need to be studied by future research.

摘要

自身免疫性脑炎是一种日益被认识到的脑炎病因。大多数病例系列报道的患者居住在北半球的发达国家。拉丁美洲自身免疫性脑炎的流行病学特征仍不清楚。本研究的目的是对拉丁美洲自身免疫性脑炎的临床表现进行综述,并与世界文献进行比较。通过深入的文献检索确定参考文献,并根据与主题的相关性和作者的判断进行选择。我们选择了2007年至2020年7月发表的包括拉丁美洲国家患者的临床研究和病例报告。在纳入的379例患者中,大多数为抗N-甲基-D-天冬氨酸(NMDA)受体脑炎病例(93.14%),其次是抗电压门控性钾通道(VGKC)复合物脑炎(n = 17;4.48%)、抗谷氨酸脱羧酶(GAD)脑炎(n = 9;2.37%)、抗α-氨基-3-羟基-5-甲基-4-异恶唑丙酸(AMPA)受体脑炎(n = 1;0.26%)、抗γ-氨基丁酸(GABA)受体脑炎(n = 1;0.26%)、抗代谢型谷氨酸受体5(mGluR5)脑炎(n = 1;0.26%)和抗代谢型谷氨酸受体1(mGluR1)脑炎(n = 1;0.26%)。拉丁美洲报道的抗NMDA脑炎病例女性略占优势,相关肿瘤的患病率较低,脑电图上极端δ刷的发生率较低。在欠发达国家,自身免疫性脑炎可能未得到充分诊断。然而,根据现有病例报告和病例系列,其治疗后的结果在拉丁美洲患者中似乎与发达国家报道的同样良好。自身免疫性脑炎表现的区域特异性可能与流行病学因素有关,如存在不同的触发因素以及不同的遗传和免疫背景,未来的研究需要对此进行探讨。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e53/7859257/019ffed7a2c2/fneur-11-606350-g0001.jpg

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