Lin Shang-Chiang, Lu Jeng-Wei, Lin Ting-Chun, Sung Yueh-Feng, Ho Yi-Jung, Wang Fu-Min, Lui Shan-Wen, Hsieh Ting-Yu, Wang Kuang-Yih, Liu Feng-Cheng
Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Biotech Research and Innovation Centre, University of Copenhagen, Copenhagen, Denmark.
In Vivo. 2025 Jan-Feb;39(1):539-547. doi: 10.21873/invivo.13858.
BACKGROUND/AIM: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, though rare, is the most common form of autoimmune encephalitis, predominantly affecting young individuals, particularly females. Standard treatments include corticosteroids, intravenous immunoglobulins (IVIG), and plasmapheresis, with rituximab recommended for those unresponsive to first-line therapies. However, reliable biomarkers for clinical assessment remain elusive. This study investigated the efficacy of adjunctive hydrogen therapy in a patient with anti-NMDAR encephalitis.
This case report describes a 14-year-old boy with anti-NMDAR encephalitis who exhibited poor response to initial treatment, but showed significant improvement with rituximab and adjunctive hydrogen therapy. Immunophenotyping revealed correlations between treatment outcomes and shifts in B cell subsets, PD-1+ cytotoxic T cells, and regulatory T cell subtypes.
This case underscores the importance of integration traditional clinical assessments with advanced diagnostics such as flow cytometry-based immunophenotyping, and suggests a potential role for hydrogen therapy in modulating immune response in this complex autoimmune condition.
背景/目的：抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎虽然罕见，但却是自身免疫性脑炎最常见的形式，主要影响年轻人，尤其是女性。标准治疗方法包括使用皮质类固醇、静脉注射免疫球蛋白（IVIG）和血浆置换，对于一线治疗无反应的患者推荐使用利妥昔单抗。然而，用于临床评估的可靠生物标志物仍然难以捉摸。本研究调查了辅助氢疗法在一名抗NMDAR脑炎患者中的疗效。
本病例报告描述了一名患有抗NMDAR脑炎的14岁男孩，其对初始治疗反应不佳，但在使用利妥昔单抗和辅助氢疗法后有显著改善。免疫表型分析揭示了治疗结果与B细胞亚群、PD-1 + 细胞毒性T细胞和调节性T细胞亚型变化之间的相关性。
本病例强调了将传统临床评估与基于流式细胞术的免疫表型分析等先进诊断方法相结合的重要性，并提示氢疗法在调节这种复杂自身免疫性疾病的免疫反应中可能发挥作用。
