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儿科人群自身免疫介导的神经系统疾病的临床谱

The Clinical Spectrum of Autoimmune-Mediated Neurological Diseases in Paediatric Population.

作者信息

Lubarski Karol, Mania Anna, Michalak Sławomir, Osztynowicz Krystyna, Mazur-Melewska Katarzyna, Figlerowicz Magdalena

机构信息

Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland.

Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland.

出版信息

Brain Sci. 2022 Apr 29;12(5):584. doi: 10.3390/brainsci12050584.

Abstract

Neurological autoimmune diseases have various origins and pathogeneses. Specific antibodies are associated with paraneoplastic syndromes, other infectious agents, or inherited disorders. We aim to evaluate the relation between the autoantibodies, the chosen symptoms, demographic characteristics, and infection history. We retrospectively analysed 508 children during neurological diagnostics. We investigated serum antineuronal, IgG, IgM anti-ganglioside, and anti-aquaporin-4 in both the serum and cerebrospinal fluid (CSF) anti-cell surface and anti-synaptic protein antibodies in 463, 99, 44, 343, and 119 patients, respectively. The CSF polymerase chain reaction detection of Herpesviridae, enterovirus, B19 parvovirus, adenovirus, and parechovirus involved 261 patients. We included available clinical information and electroencephalographic, radiologic, and microbiological results. The IgM anti-ganglioside antibodies increased the risk of tics and positive symptoms ( = 0.0345, = 0.0263, respectively), the anti-glutamic acid decarboxylase particle of paresis ( = 0.0074), and anti-neuroendothelium of mutism ( = 0.0361). Anti-neuroendothelium, IgM anti-ganglioside, and CSF anti-N-methyl-D-aspartate antibodies were more often associated with consciousness loss ( = 0.0496, = 0.0044, = 0.0463, respectively). Anti-myelin antibodies co-occured with Herpes simplex virus (HSV)-2 IgG ( = 0.0415), anti-CV2 with HSV-1 IgM ( = 0.0394), whereas anti-glial fibrillary acidic protein was linked with past Epstein-Barr virus infection. The anti-ganglioside IgM and anti-myelin particles were bilaterally correlated ( = 0.0472). The clinical pictures may overlap, requiring specialistic diagnostics. We noticed the links between the infection aetiology and the specific autoantibody's positivity.

摘要

神经自身免疫性疾病有多种起源和发病机制。特定抗体与副肿瘤综合征、其他感染因子或遗传性疾病相关。我们旨在评估自身抗体、所选症状、人口统计学特征和感染史之间的关系。我们对508名儿童进行神经诊断时进行了回顾性分析。我们分别在463例、99例、44例、343例和119例患者中检测了血清抗神经元抗体、IgG、IgM抗神经节苷脂抗体以及血清和脑脊液(CSF)中的抗水通道蛋白4抗体、抗细胞表面和抗突触蛋白抗体。对261例患者进行了脑脊液聚合酶链反应检测疱疹病毒科、肠道病毒、B19细小病毒、腺病毒和副肠孤病毒。我们纳入了可用的临床信息以及脑电图、放射学和微生物学结果。IgM抗神经节苷脂抗体增加了抽动和阳性症状的风险(分别为P = 0.0345,P = 0.0263),抗谷氨酸脱羧酶颗粒与麻痹相关(P = 0.0074),抗神经内皮细胞抗体与缄默症相关(P = 0.0361)。抗神经内皮细胞抗体、IgM抗神经节苷脂抗体和脑脊液抗N-甲基-D-天冬氨酸抗体更常与意识丧失相关(分别为P = 0.0496,P = 0.0044,P = 0.0463)。抗髓磷脂抗体与单纯疱疹病毒2型IgG同时出现(P = 0.0415),抗CV2抗体与单纯疱疹病毒1型IgM同时出现(P = 0.0394),而抗胶质纤维酸性蛋白与既往EB病毒感染有关。抗神经节苷脂IgM和抗髓磷脂颗粒呈双侧相关性(P = 0.0472)。临床表现可能重叠,需要专业诊断。我们注意到感染病因与特定自身抗体阳性之间的联系。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a93f/9138824/eed967e79471/brainsci-12-00584-g001.jpg

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