Ho T W, Willison H J, Nachamkin I, Li C Y, Veitch J, Ung H, Wang G R, Liu R C, Cornblath D R, Asbury A K, Griffin J W, McKhann G M
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Neurol. 1999 Feb;45(2):168-73. doi: 10.1002/1531-8249(199902)45:2<168::aid-ana6>3.0.co;2-6.
Immunopathological studies suggest that the target of immune attack is different in the subtypes of Guillain-Barré syndrome (GBS). In acute motor axonal neuropathy (AMAN), the attack appears directed against the axolemma and nodes of Ranvier. In acute inflammatory demyelinating polyneuropathy (AIDP), the attack appears directed against a component of the Schwann cell. However, the nature of the antigenic targets is still not clear. We prospectively studied 138 Chinese GBS patients and found that IgG anti-GD1a antibodies were closely associated with AMAN but not AIDP. With a cutoff titer of greater than 1:100, 60% of AMAN versus 4% of AIDP patients had IgG anti-GD1a antibodies; with a cutoff titer of greater than 1:1,000, 24% of AMAN patients and none of the AIDP patients had IgG anti-GD1a antibodies. In contrast, low levels of IgG anti-GM1 antibodies (> 1:100) were detected in both the AMAN and the AIDP forms (57% vs 35%, NS). High titers of IgG anti-GM1 (>1:1,000) were more common in the AMAN form (24% vs 8%, NS). Serological evidence of recent Campylobacter infection was detected in 81% of AMAN and 50% of AIDP patients, and anti-ganglioside antibodies were common in both Campylobacter-infected and noninfected patients. Our results suggest that IgG anti-GD1a antibodies may be involved in the pathogenesis of AMAN.
免疫病理学研究表明，格林-巴利综合征（GBS）各亚型的免疫攻击靶点有所不同。在急性运动轴索性神经病（AMAN）中，攻击似乎针对轴膜和郎飞结。在急性炎症性脱髓鞘性多发性神经病（AIDP）中，攻击似乎针对施万细胞的一种成分。然而，抗原靶点的性质仍不清楚。我们对138例中国GBS患者进行了前瞻性研究，发现IgG抗GD1a抗体与AMAN密切相关，而与AIDP无关。当临界滴度大于1:100时，60%的AMAN患者与4%的AIDP患者有IgG抗GD1a抗体；当临界滴度大于1:1000时，24%的AMAN患者有IgG抗GD1a抗体，而AIDP患者均无。相比之下，在AMAN和AIDP两种类型中均检测到低水平的IgG抗GM1抗体（>1:100）（57%对35%，无显著性差异）。高滴度的IgG抗GM1（>1:1000）在AMAN类型中更常见（24%对8%，无显著性差异）。81%的AMAN患者和50%的AIDP患者检测到近期空肠弯曲菌感染的血清学证据，抗神经节苷脂抗体在空肠弯曲菌感染和未感染的患者中均很常见。我们的结果表明，IgG抗GD1a抗体可能参与了AMAN的发病机制。
