肌炎特异性自身抗体在多发性肌炎/皮肌炎及其他神经肌肉疾病的表达

目的 探讨肌炎特异性自身抗体(MSAs)在多发性肌炎/皮肌炎(PM/DM)及其他神经肌肉疾病的敏感度和特异度.方法 采用免疫斑点分析法测定63例PM/DM(PM/DM组)及60例神经肌肉疾病(非肌炎)患者(对照组)的血清抗Jo-1抗体和抗SRP抗体水平,分析其对PM/DM诊断的敏感度和特异度.结果 PM/DM组抗Jo-1和抗SRP抗体阳性率分别为17%和5%,对照组均为阴性.两种抗体诊断PM/DM特异度均为100%(95%CI:94%～100%),总敏感度为22%(95%CI:13%～34%).结论 抗Jo-1和抗SRP自身抗体对PM和DM特异度高.     

血清抗核抗体在视神经脊髓炎谱系疾病和多发性硬化中的分布

目的 研究血清抗核抗体(ANAs)在视神经脊髓炎谱系疾病(NMOSDs)和多发性硬化(MS)中的分布.方法 收集2009-01-2011-03间在作者医院神经内科门诊和住院诊治并行血清ANAs筛查的NMOSDs患者74例,包括视神经脊髓炎(NMO)53例、复发长节段横贯性脊髓炎(rLETM)20例和复发性视神经炎(RON)1例,以及MS患者49例,统计其血清ANAs阳性率并进行分析.结果 NMOSDs患者血清ANAs阳性率为45.9%(34/74),其中ANA(本文中特指用间接免疫荧光法检测的抗核抗体)、抗dsDNA、抗着丝粒抗体(ACA)、抗SSA抗体、抗SSB抗体阳性率分别为36.5%(27/74)、5.4%(4/74)、1.4%(1/74)、27.0%(20/74)、9.5%(7/74),MS组仅1例ANAs阳性,阳性率为2.0%(1/49),两组间差异有统计学意义(P<0.01).血清ANAs诊断NMOSDs的灵敏度为45.9%,特异度达98.0%;NMO和rLETM患者血清ANAs阳性率分别为47.2%和40.0%,两者无统计学差异(P=0.635).结论 NMO和rLETM患者血清ANAs阳性率高于MS组,支持NMO和rLETM同属于NMOSDs的观点.ANAs有可能是NMOSDs和MS两组疾病的鉴别指标之一.     

抗心磷脂抗体与脑梗塞

目的：探讨抗心磷脂抗体与脑梗塞的关系。方法：采用酶联免疫吸附法，检测46例脑梗塞患者（脑梗塞组）和20例非心脑血管病患者（对照组）血清中抗心磷脂抗体（ACLA）。结果：在脑梗塞组中．阳性率41％，对照组阳性率15％，两组间有显著性差异（P＜0．05）。脑梗塞ACLA阳性组和阴性组对比分析．ACLA阳性组复发性、多灶性与ACLA阴性组有显著性差异（P值分别＜0．05和＜0．01）。同时ACLA阳性组血小板聚集率、血粘度也明显高于ACLA阴性组（P值均＜0．05）。糖尿病、高血脂、吸烟者ACLA阳性组与ACLA阴性组无明显差异。结论：抗心磷脂抗体是脑梗塞的危险因素。     

重症肌无力患者抗骨骼肌抗心肌抗体与心脏损害

目的探讨重症肌无力（ＭＧ）合并心脏损害的发病机制。方法采用无创性心脏检查对５６例ＭＧ患者进行心电图、彩色多普勒二维超声心动图和心肌酶学检查;并应用免疫荧光技术,对其中４９例ＭＧ患者测定抗骨骼肌抗心肌抗体（ＳＨ－Ａｂ）。以正常人作对照检查。结果心电图异常率３０．３５％,超声心动图异常率１０．７１％,心肌酶学异常率４１．０７％。ＳＨ－Ａｂ阳性率４８．９％,对照组无１例有ＳＨ－Ａｂ。还发现伴心肌酶异常的ＭＧ患者ＳＨ－Ａｂ阳性率６９．６％（１６／２３）,心肌酶正常的患者ＳＨ－Ａｂ阳性率仅为３０．８％（８／３０）,伴胸腺瘤者（ＭＧＴ）ＳＨ－Ａｂ阳性率为４１．６％（５／１２）,不伴胸腺瘤者（ＭＧＮＴ）ＳＨ－Ａｂ阳性率仅为２４．３２％（９／３７）。另外,ＭＧＴ心电图、心肌酶学异常率均为５０％,均明显高于ＭＧＮＴ。结论ＭＧ的心脏损害可能与ＳＨ－Ａｂ滴度增高抗原抗体结合等自身免疫机制有关。     

抗髓鞘碱性蛋白抗体及抗髓鞘少突胶质细胞糖蛋白抗体在中枢神经系统炎性脱髓鞘疾病诊断中的价值

目的探讨抗髓鞘碱性蛋白抗体(抗MBP抗体)及抗髓鞘少突胶质细胞糖蛋白抗体(抗MOG抗体)在中枢神经系统炎性脱髓鞘疾病中的表达率,并研究两种抗体对该病的临床诊断价值。方法选取我院于2012-03—2013-09收治的中枢神经系统炎性脱髓鞘疾病患者90例为实验组(MS组30例,AM组30例,NMO组30例);同时选取45例非中枢神经系统炎性疾病患者为对照组。应用ELISA方法对各组患者血清和脑脊液中抗MBP抗体、抗MOG抗体进行检测,并对比分析各组及各亚组之间表达水平差异。结果实验组在血清及CSF中的抗MOG抗体和抗MBP抗体水平均明显高于对照组(P0.05)。而各组的血清抗体阳性率与CSF差异无统计学意义(P0.05)。MS组与AM组血清及CSF中抗MOG抗体阳性率均显著低于NMO组(P0.05)。MS组血清中抗MBP抗体阳性率明显高于AM组(χ2=4.356,P0.05),其余各亚组及CSF中的抗MBP抗体水平均无显著差异(P0.05)。而MS组血清中的抗MBP抗体阳性率显著高于CSF组(χ2=5.963,P0.05)。结论中枢神经系统炎性脱髓鞘疾病患者中抗MBP抗体、抗MOG抗体高表达,对疾病诊断具有临床意义;同时血清中的抗MOG抗体和抗MBP抗体含量差异可辅助疾病各亚型的鉴别诊断。     

炎性周围神经病患者血清和脑脊液中抗硫脂抗体的临床意义

目的　通过测定炎性周围神经病患者血清和脑脊液 ( CSF)中抗硫脂抗体水平 ,探讨其临床意义和可能的致病机制。方法　应用 ELISA法检测 3 0例急性吉兰 -巴雷 ( Guillain-Barré syndrome,GBS)患者、2 4例慢性吉兰 -巴雷 ( chronic inflammatory demyelinating polyradiculoneuropathy,CIDP)患者血清和 CSF中抗硫脂抗体水平。结果　 ( 1 ) GBS患者血清中高滴度抗硫脂抗体与疾病组和正常对照组比较差异无显著性 ( P >0 .0 5 ) ;CSF中 Ig M-抗硫脂抗体阳性率与各对照组比较差异有极显著性 ( P <0 .0 1 ) ;( 2 ) CIDP患者血清中高滴度抗硫脂抗体与正常对照组比较差异有显著性 ( P <0 .0 5 ) ,CSF中 Ig M-抗硫脂抗体阳性率与各对照组比较差异有显著性( P <0 .0 5 ) ;( 3 )抗硫脂抗体阳性的 GBS患者多有主观感觉障碍 ,差异有显著性 ( P <0 .0 5 ) ;抗硫脂抗体阳性的CIDP患者多为感觉轴索性损害 ,差异有显著性 ( P<0 .0 5 ) ;( 4 )轻、重型组 GBS患者血清和 CSF中抗硫脂抗体水平之间差异无显著性 ( P >0 .0 5 ) ;( 5 ) GBS组、CIDP组血清中抗体水平与配对的 CSF中抗体水平无相关性。结论　 ( 1 ) GBS患者 CSF中 Ig M-抗硫脂抗体有可能作为感觉神经受累的一项临床辅助参考指标 ,抗硫脂抗体的水平与疾病的临床严重     

抗心磷脂抗体与脑梗死关系的研究

目的探讨抗心磷脂抗体(ACA)与脑梗死(C I)的关系。方法应用酶联免疫吸附(ELISA)法检测137例C I患者发病后第1 d、第1周、第2周、第3周、第4周末时血清ACA阳性率,并与短暂性脑缺血发作(TIA)组、脑出血(ICH)组及正常对照组比较。结果C I组ACA阳性率(64.9%)明显高于TIA组(24.6%)、ICH组(33.6%)、正常对照组(17.6%)(均P<0.01);C I组ACA阳性率随病程进展逐渐下降,第1周末与第2周、第3周、第4周末比较差异均有显著性(P<0.05~0.01);C I组中≤50岁患者ACA阳性率明显高于>50岁患者(P<0.01),ACA阳性者3年内再发C I明显高于阴性者(P<0.01)。结论C I患者急性期ACA阳性率高,尤其是≤50岁的患者;随病程演变CAC阳性率逐渐降低,ACA阳性者3年内复发率高。     

缺血性卒中与抗心磷脂抗体检测的研究

目的探讨抗心磷脂抗体(ACA)阳性与缺血性卒中的相关性.方法采用ELISA方法对63例缺血性卒中及其对照组血清ACA进行了检测,并对其结果进行比较.结果缺血性卒中组阳性率明显高于疾病对照组和健康对照组(P＜0.01).结论ACA是缺血性卒中的危险因素之一.     

抗心磷脂抗体与脑血管病关系的研究

目的:探讨抗心磷脂抗体(aCL)与脑血管病(CVD)的关系。方法:检测266例缺血性脑血管病(ICVD)患者和73例脑出血(CH)患者血清aCL。结果:ICVD患者aCL阳性率高于对照组(P<0.01),且IgG型aCL比IgM型aCL阳性率升高(P<0.01)。CH患者aCL阳性率高于对照组(P<0.01)。ICVD组aCL阳性率与CH组比较无显著性差异(P>0.05),ICVD组、CH组和对照组不同性别间aCL阳性率无显著性差异(P>0.05)。结论:aCL可作为CVD危险性增加的指标,对CVD的预测有一定意义,包括ICVD和CH患者,aCL阳性率男女性别之间无差异。     

抗心磷脂抗体与脑血管病关系的研究

目的探讨抗心磷脂抗体与脑血管病的关系．方法采用酶联免疫吸附试验对105例脑梗塞及48例脑出血患者的血清ACLA进行了检测，并与对照组50例结果进行比较。结果脑出血及脑梗塞组的ACLA阳性率明显高于对照组（P＜0．01），ACLA分型中，脑出血及脑梗塞组中的IgG型ACLA阳性率也明显高于对照组（P＜0．05，P＜0．01）．结论ACLA是脑出血及脑梗塞的危险因素，其中IgG型ACLA为主要致病性抗体。     

Anti-MAG antibody and antibody complexes: detection by radioimmunoassay

A radioimmunoassay (RIA) for measuring isotype-specific antibodies to the myelin-associated glycoprotein (MAG) was developed using radiolabeled CNS MAG in a double-antibody precipitation system. Anti-MAG activity was detected by RIA only in patients with neuropathy and anti-MAG M proteins. Anti-MAG IgM or IgG antibodies were not detected in serum of patients with Guillain-Barré syndrome, chronic relapsing polyneuritis, or multiple sclerosis (MS). Some patients with anti-MAG IgM M proteins also had complexes of IgG or IgA bound to the M protein. In one patient, anti-CNS MAG activity was detected by RIA, but not by ELISA or immunoblot. Anti-MAG antibody activity in patients with neuropathy seems to be isotypically restricted, and there is no evidence for antibody reactivity to MAG in other demyelinating diseases.     

Monoclonal antibody therapies and neurologic disorders

The role of monoclonal antibody (mAb) therapies in treating medical conditions has expanded tremendously since its inception in the 1970s, and their use in neurologic conditions has increased in just the past few years. Currently, mAb treatments are being tested in conditions ranging from neuromuscular disorders to demyelinating diseases. What is now considered experimental therapy may soon become common. In addition, neurologic adverse effects have been reported during the use of mAb therapy in nonneurologic conditions that neurologists should be able to recognize. Because of the rapid increase in the use of mAb treatments, this review highlights their use in neurologic conditions and their neurologic adverse effects.     

Ma2 antibody and multiple mononeuropathies

Anti-Ma2 antibodies belong to a family of onconeuronal antibodies that target proteins expressed in brain, testis and several tumors. Previously observed in patients presenting with limbic encephalitis, they seem to be associated with several other paraneoplastic syndromes. We report the case of a 73-year-old woman presenting sensory and motor neuropathy associated with non-small-cell lung cancer who had Ma2-antibodies.     

Single-fiber electromyography in limb and facial muscles in muscle-specific kinase antibody and acetylcholine receptor antibody myasthenia gravis

We examined the findings from single-fiber electromyography in extensor digitorum communis (EDC) and orbicularis oculi (OOc) in 13 myasthenia gravis (MG) patients with muscle-specific kinase antibodies (MuSK-MG) and 12 MG patients with acetylcholine receptor antibodies (AChR-MG) with similar clinical scores. More than 70% of AChR-MG patients had abnormal jitter in both EDC and OOc, but the majority of MuSK-MG patients had normal jitter in EDC despite abnormal jitter in OOc. These findings demonstrate clear differences between the neurophysiology of MuSK-MG and AChR-MG.     

Myasthenia gravis with anti-acetylcholine receptor antibody or anti-muscle specific kinase antibody

Patients with myasthenia gravis (MG) are divided into 3 groups: anti-acetylcholine receptor antibody-positive MG (AChR MG), anti-muscle specific kinase antibody-positive MG (MuSK MG), and AChR-and MuSK-negative MG (double seronegative MG; double SNMG). A recent study on the detection of low-affinity antibodies binding to AChR showed the presence of AChR antibodies in about 70% of double SNMG patients. There is accumulating evidence that double SNMG patients are similar to AChR-MG patients with respect to clinical features and thymic pathology. Since most MG patients are thought to belong to the AChR-MG or MuSK-MG group of patients, this article reviews the pathophysiology, clinical features, and treatments in these 2 groups of MG patients. The pathophysiology of AChR-MG is closely related to the abnormal thymic pathology, such as thymic hyperplasia or presence of thymoma, and thy(mo)mectomy is recommended in patients with generalized AChR-MG. On the contrary, little thymic abnormality in patients with MuSK-MG discourages thymectomy; however, MuSK-MG patients do respond to thymectomy and therefore studies to define the indications of thymectomy in MuSK-MG patients are required. The responses to cholinesterase inhibitors are poor in patients with MuSK-MG, and these patients tend to show hyperactivity to the Tensilon test, such as fasciculation of facial muscles and stuffy sensation in the throat. The adverse responses to a small dose of intravenous edrophonium chloride injection may support the clinical diagnosis of MuSK-MG. Further, only small doses of acetylcholinesterase inhibitors are administered to patients with MuSK-MG in order to avoid cholinergic hyperactivity. In general, both types of MG patients respond well to treatments with immunosuppressants, including steroids, but some patients with MuSK-MG show persistent bulbar symptoms.     

动态监测脑血管病患者抗心磷脂抗体及ENA多肽抗体的临床意义

采用酶联免疫吸附法与免疫印迹法动态监测５０例脑梗塞和４０例脑出血患者的抗心磷脂抗体及测定部分患者有ＥＮＡ多肽抗体。结果仅ＩｇＧ型ａＣｌ与ＥＮＡ多肽性在急性脑血管病患者显著升高，两者在ＣＩ与ＣＨ组的阳性率分别为１２．０％，１２．５％与３９．０％，４３．３％，与正常对照组０．０％及１６．％相比，Ｐ〈０．０５。