抗NMDA受体脑炎的临床和脑电图特点

目的：研究抗N-甲基-M-天冬氨酸（NMDA）受体脑炎患者的临床特点,以提高对这种自身免疫性疾病的认识。方法：对3例经血清（其中1例并作脑脊液）抗NMDA受体抗体检测诊为抗NMDA受体脑炎的患者,对病史、认知功能、脑脊液、头颅影像学、EEG、妇科B超、治疗方案等资料进行详细分析,并随访3～6个月。结果：3例患者均为女性,起病年龄13岁（2例）和25岁,以精神异常和癫痫发作为首发症状,病程中表现出意识障碍、运动障碍、语言障碍和认知障碍。脑脊液、头颅MRI和EEG表现为非特异改变,未发现伴发肿瘤。病程3～6个月。结论：抗NMDA受体脑炎临床表现易与病毒性脑炎混淆,对于不明原因的脑炎,尤其病程较长者,应尽早进行抗NMDA受体抗体检测。     

免疫球蛋白及相关抗体检测在自身免疫性脑炎诊断中的应用

为探讨血清Ig、脑脊液Ig及自身免疫性脑炎(autoimmune encephalitis,AE)相关抗体检测在首发认知和精神行为异常的AE诊断中的应用价值,选取56例AE患者为试验组,56例病毒性脑炎患者为对照组。对比2组患者血清IgM、血清IgG、脑脊液IgG水平,脑脊液白蛋白/血清白蛋白比值,IgG指数及血清、脑脊液AE相关抗体检出情况。试验组均予以激素、Ig等系统治疗,比较试验组治疗前后血清IgM、血清IgG、脑脊液IgG水平,脑脊液白蛋白/血清白蛋白比值及IgG指数。结果显示,试验组血清IgM、血清IgG、脑脊液IgG水平,脑脊液白蛋白/血清白蛋白比值,IgG指数及IgG指数0.7的人数比例均高于对照组(P0.05);试验组抗N-甲基-D-天冬氨酸(anti-N-methyl-D-aspartate,NMDA)受体抗体、抗富亮氨酸胶质瘤失活1蛋白(leucine-rich glioma inactivation 1 protein,LGI1)抗体检出率均高于对照组(P0.05);试验组治疗后血清IgM、血清IgG、脑脊液IgG水平,脑脊液白蛋白/血清白蛋白比值及IgG指数均较治疗前降低(P0.05)。提示首发认知和精神行为异常的AE患者血清、脑脊液Ig水平明显升高,且存在不同类型AE相关抗体,血清、脑脊液Ig水平也与疾病病程进展密切相关,可将其作为疾病早期诊断及病程监测的重要指标。     

脑炎与人微小病毒B19感染-附1例PCR检测结果分析

我室用多聚酶链反应技术及ELISA法对1例临床拟诊为脑炎志儿的血清及脑脊液分别作了人微小病毒B19-DNA及该病毒特异性IgM、IgG抗体检测。其结果血清及脑脊液B19特异性IgM抗体均为强阳性；血清B19特异性IgG抗体阴性．脑脊液B19特异性IgG抗体强阳性；血清中检出B19-DNA。在国内首次提示人微小病毒B19感染与脑炎的发生有关。     

脑炎与人微小病毒B19感染─附1例PCR检测结果分析

我室用多聚酶链反应技术及ＥＬＩＳＡ法对１例临床拟诊为脑炎患儿的血清及脑脊液分别作了人微小病毒Ｂ１９－ＤＮＡ及该病毒特异性ＩｇＭ、ＩｇＧ抗体检测。其结果血清及脑脊液Ｂ１９特异性ＩｇＭ抗体均为强阳性；血清Ｂ１９特异性ＩｇＧ抗体阴性、脑脊液Ｂ１９特异性ＩｇＧ抗体强阳性；血清中检出Ｂ１９－ＤＮＡ。在国内首次提示人微小病毒Ｂ１９感染与脑炎的发生有关。     

自身免疫性脑炎患者外周血Tfh 细胞的检测及其临床意义

目的:研究滤泡辅助性T 细胞(Tfh)在自身免疫性脑炎(AE)患者外周血中的百分比及临床意义。方法: 采用自身免疫性脑炎相关抗体检测阳性的患者脑脊液与大鼠脑组织冰冻切片共孵育并进行免疫荧光染色,观察结果;于收集血清和/ 或脑脊液(CSF)检查自身免疫性脑炎相关抗体阳性的患者17 例(其中,3 例为抗LGI1 抗体阳性患者,3 例为抗GABAR抗体阳性患者,10 例为抗NMDAR 抗体阳性患者,1 例为抗NMDAR 抗体、抗GABAR 抗体及抗AMPA2 抗体合并阳性患者),收集外周血样本共计21 例次:未治疗组6 例次,治疗组15 例次(其中,治疗后缓解组8 例次,治疗后未缓解组7 例次),健康对照者(对照组)外周血15 例。采用流式细胞术(FCM)检测外周血单个核细胞(PBMC)中CD3+ CD4+ CXCR5+ PD1+(即Tfh 细胞)的比例,并分析Tfh 细胞比例与患者疾病恢复程度的相关性。结果:淤自身免疫性脑炎相关抗体检测阳性患者脑脊液与大鼠脑组织冰冻切片共孵育免疫荧光染色结果呈现明显阳性反应; 流式细胞术检测结果显示未治疗组患者外周血Tfh 比例明显高于对照组(P<0.001),且治疗未缓解组患者Tfh 比例高于治疗缓解组(P<0.05),而治疗缓解组患者Tfh 比例与对照组比较,差异无统计学意义(P =0.107)。结论:自身免疫性脑炎患者外周血Tfh 比例升高可能与疾病的发生发展相关。     

重症肌无力——肌无力严重度与AChR Ab相对滴度密切相关

重症肌无力(MG)是累及神经—肌肉接头处突触后膜上乙酰胆碱受体(AChR)的自身免疫性疾病,主要由抗体介导。一般报导MG病人的临床分类与抗乙酰胆碱受体抗体(AChR Ab)滴度相关不密切,甚至认为MG临床严重度与AChR Ab滴度无关。本文通过33例重症肌无力病人150例次抗乙酰胆碱受体抗体测定,经直线回归和相关性研究,证明MG病人的肌无力严重程度与其血清AChR Ab相对滴度密切相关。现将结果报告如下。     

异种AchR检测抗AchR抗体的评价

<正> 自重症肌无力病人血清中发现抗乙酰胆碱受体(AchR)抗体以来,检测病人血清中抗AchR抗体已成为诊断此病的重要手段。常用的检测抗原为去神经化的哺乳动物骨骼肌或人骨骼肌提取的乙酰胆碱受体粗制品,其中以人源AchR应用最多,结果较理想。然而,提取人源AchR抗原有许多不便和     

我国狂犬病病原学和病理形态学观察

报告四例狂犬病病例及对其尸脑组织的病原学和病理形态学观察。４例病人均有被犬咬伤史；发病后临床病状典型，表现为发热、恐水、怕风等；潜伏期和病程分别在２０～１３２天和７～１４天；临床诊断明确。死亡后尸检脑组织病理改变为病毒性脑炎病变，在感染神经细胞胞浆内均检到内基氏体。从尸脑组织中分离出狂犬病毒４株。又从４例病人血清中和２例病人脑脊液中分别检测出特异性狂犬病毒抗体各１例。     

抗神经元和抗心磷脂抗体对中枢型SLE诊断的意义

用间接免疫荧光技术和ELISA法检测神经精神性狼疮(NPLE)和非NPLE患者,非SLE脑血管疾病患者及正常人血清和脑脊液中抗神经元抗体、抗心磷脂抗体。结果显示NPLE患者血清和脑脊液中这两种抗体的阳性率与其它患者相比,有显著差异。提示这两种抗体的检测有助于NPLE的临床诊断。     

重症肌无力患者对多核苷酸的抗体

作者研究了100例重症肌无力患者和45例其他神经肌肉病病人,测定这两种病人的血清中对多核苷酸,多核苷酸—多核尿苷酸及天然和变性的DNA抗体。全部重症肌无力患者均可检测到抗乙酰胆(卤咸)受体的抗体,平均滴度为1.2×10~(-7)M。用微孔滤膜放射免疫试验法检查病人血清中的抗多核苷酸抗体,结果48％的重症肌无力病人有此抗体,     

Variable response to therapeutic plasma exchange in pediatric anti-NMDA receptor encephalitis

IntroductionAnti-NMDA receptor encephalitis in an acute form generally presents with abnormal movements and psychiatric symptoms. Therapeutic plasma exchange has been considered to be one of the first line treatment options. This report highlights the role of plasma exchange in anti-NMDA receptor encephalitis in pediatric patients.MethodsThis is a retrospective analysis of four cases of a severe form of encephalitis due to anti-NMDA receptor antibody. All these four patients were evaluated for clinical and laboratory profile before plasma exchange. Plasma exchange was performed with Cobe Spectra Version 7.0(Terumo BCT, USA), and 5% albumin and fresh frozen plasma were used as replacement fluid.ResultsA total of 20 procedures (range: 2–8/patient) were performed on four patients on an alternate day basis. Slow recovery and long-term hospitalization (range: 25–70 days) was observed in all these patients and may be due to delayed initiation of plasma exchange. One patient was lost in follow up while another one had fatal consequences after one month of discharge from the hospital.ConclusionEarly diagnosis and timely initiation of therapeutic plasma exchange along with immunosuppressive therapy hasten the recovery, duration of hospitalization and yield a better outcome.     

Antibody Capture Immunoassay Detection of Japanese Encephalitis Virus Immunoglobulin M and G Antibodies in Cerebrospinal Fluid

Immunoglobulin M (IgM) and IgG antibodies to Japanese encephalitis virus (JEV) were detected in acute-phase cerebrospinal fluid (CSF) specimens from patients with acute encephalitis by using a solid-phase radioimmunoassay of the antibody capture type. Of 12 patients with JEV infections subsequently proven by hemagglutination inhibition serology, 11 had JEV IgM antibodies, as measured by antibody capture radioimmunoassay, in the first CSF specimen (geometric mean titer, 1:2,500) compared with 0 of 8 patients with acute encephalitis proven not to be due to JEV. Specific IgM anti-JEV activity (units per microgram) was greater in CSF than in parallel serum specimens in all 11 positive cases by more than fourfold on the average (range, 1.4 to 13). Among seven patients with broadly reactive hemagglutination inhibition seroresponses typical of persons previously exposed to other flaviviruses, six had high levels of JEV IgG antibodies (as measured by antibody capture radioimmunoassay) in their acute-phase CSF (geometric mean titer, 1:26,000), whereas in five patients experiencing their first flavivirus infection, JEV IgG antibodies measured by antibody capture radio-immunoassay were either absent (one patient) or weakly reactive (four patients; geometric mean titer, 1:3,200). Specific IgG anti-JEV activity was greater in CSF than in parallel serum specimens in eight of the nine positive cases measured (range, 1.3- to 24-fold). The antibody capture solid-phase immunoassay approach is well suited for detecting specific antibody activity in CSF.     

Acute limbic encephalitis: A new entity?

Clinical cases similar to herpes simplex virus (HSV) encephalitis have accumulated in Japan. Detailed examinations have failed to demonstrate HSV infection. Recently, these cases have been named "non-herpetic acute limbic encephalitis". Only a single autopsy case was so far reported in an abstract form, because many cases showed a good prognosis. The case presented here was that following fever, a 59-year-old woman developed disturbance of consciousness and uncontrollable generalized seizures. Brain MRI revealed abnormal signals in the bilateral medial temporal lobe and along the lateral part of the putamen. Autoantibody against the NMDA glutamate receptor (GluR) IgM-epsilon2 was detected in the serum, and the GluR IgG-delta2 antibody was positive in cerebrospinal fluid. She died 12 days after onset. An autopsy examination revealed scattered foci consisting of neuronal loss, neuronophagia and some perivascular lymphocytic infiltration in the hippocampus and amygdala, but no haemorrhagic necrosis in the brain. HSV-1, -2 and human herpes virus-6 were negative immunohistochemically. We believe that our autopsy case may contribute to understanding the neuropathological background of non-herpetic acute limbic encephalitis.     

Clinical characteristics and laboratory assay of adult Japanese encephalitis patients in an outbreak in Yuncheng, Shanxi Province, 2006]

OBJECTIVE: To study the clinical and laboratory characteristics of adult Japanese encephalitis (JE) patients in a JE outbreak in Yuncheng, Shanxi Province in 2006. METHOD: All the clinical data from the Second People's Hospital in Yuncheng city were analyzed, part of patients' sera and cerebrospinal fluid were tested by serology and RT-PCR. RESULTS: The majority of patients were middle-aged and elderly, 77.8% (35/45) of the total cases were more than 40 years old. Severe and fulminating type cases accounted for 60.0% (27/45). Most patients had underlying diseases. IgM antibody to JE virus (JEV) in serum was positive in each of the 45 patients analyzed and 4-fold or greater rise in sera neutralization antibody titer were found in convalescent serum. JEV nucleic acid was positive in part of cerebrospinal fluid specimens. CONCLUSION: Viral encephalitis emerged in Yuncheng city, Shanxi Province was Japanese encephalitis B, and most of the cases belonged to elderly group.     

Varicella-zoster-associated encephalitis: detection of specific antibody in cerebrospinal fluid.

Varicella-zoster (VZ) antibody measured by indirect immunofluorescence was used to identify patients with encephalitis due to VZ virus. In 15 of 16 (94%) patients with VZ infection and clinical evidence of central nervous system involvement, VZ antibody was present at a titer of 1:2 or greater in cerebrospinal fluid. In contrast, no VZ antibody was detected in the cerebrospinal fluid of seven patients with VZ infections without clinical signs of central nervous system involvement, nor was any detected in the cerebrospinal fluid of 25 patients with malignant or demyelinating disease or encephalitis due to other viral or toxic agents. All of these patients had detectable serum VZ antibody. Thus, in this study the presence of detectable VZ antibody in cerebrospinal fluid measured by indirect immunofluorescence seemed to correlate with clinical evidence of central nervous system involvement due to this virus.     

Encephalitis and polyradiculoneuritis following rubella virus infection--a case report.

Amongst neurological complications of rubella virus infection, polyradiculoneuritis as well as encephalitis is very rare. Only one case of postrubella polyradiculoneuritis combined with encephalitis has been reported to our knowledge. A 17-years-old male presented with suspected meningoencephalitis in a recent epidemic of rubella in a southern district of Korea. He developed symmetrical hyporeflexic weakness of all four extremities with urinary disturbance several days later. Rubella IgM antibody titer (enzyme linked immunosorbent assay) was 58 AU/mL in serum and 12 AU/mL in cerebrospinal fluid. Electrophysiologic studies showed peripheral polyradiculoneuropathy with multifocal conduction block. Considering the involvement of the central nerve as well as the peripheral nerve in an adult patient, this case is thought to be valuable in view of the pathophysiology of neurologic complication in rubella virus infection.     

2006年山西省运城市成人流行性乙型脑炎临床特征与实验室检验

目的 研究2006年山西省运城市成人流行性乙型脑炎的临床及实验室检验特点,为我国乙脑预防控制提供基础资料.方法对2006年运城市第二人民医院收治的45例乙脑病例进行临床资料分析,对部分中老年患者血清和脑脊液标本进行血清学和分子生物学检测.结果收治入院的45例患者以中老年人为主,其中40岁以上病例占病例总数77.8%(35/45),重型和极重型占病例总数60.0%(27/45),大多数患者合并基础性疾病.研究结果显示,血清乙脑病毒IgM抗体检测为阳性,急性期和恢复期双份血清中和抗体存在4倍以上增高;部分患者脑脊液乙脑病毒核酸检测阳性.结论经实验室特异性检测确认山西省运城市2006年病毒性脑炎为乙型脑炎,病例呈现大年龄组发病特点.     

Virological diagnosis of herpes simplex encephalitis.

BACKGROUND: The herpes simplex encephalitis (HSE) represents one of the most severe infectious diseases of the central nervous system. As effective antiviral drugs are available, rapid and reliable diagnosis has become important. OBJECTIVES: To evaluate retrospectively the usefulness of polymerase chain reaction (PCR) as well as serological procedures for the diagnosis of HSE. STUDY DESIGN: 631 cerebrospinal fluids (CSF) from patients with clinical suspicion of encephalitis were tested for type-specific herpes simplex virus (HSV) DNA using PCR. Virus-specific antibodies including their intrathecal synthesis were measured in 624 CSF and 2409 serum samples of 2711 patients suspected of having encephalitis. RESULTS: Positive results were obtained by PCR in eight patients (1. 3%) for HSV-1 and in seven (1.1%) for HSV-2. Intrathecal antibody synthesis was estimated in 24 (3.8%) patients. In general, no intrathecal antibodies could be measured in patients with positive PCR results and vice versa the intrathecal immune response became positive when CSF was cleared from the HSV. Results of the antibody detection in serum specimens revealed an active HSV infection in 268 out of 2367 patients (11.3%). CONCLUSIONS: The detection of HSV-DNA by PCR is the method of choice for diagnosis of HSE in the early phase of the disease. During the later stage, it has to be diagnosed by the estimation of intrathecally synthesized antibodies.     

Role of serology in the diagnosis of herpes simplex encephalitis

Twenty one cerebrospinal fluid (CSF)/brain tissue (16 CSF and 5 brain tissue) from patients clinically suspected of herpes simplex encephalitis (HSE) were collected during one year period and was subjected for the detection of HSV type I and type II antigen by direct Immunofluorescence (DIF). Paired serum and CSF samples obtained from 12 patients were tested for herpes simplex virus antibodies by indirect immunofluorescence test. Of the 21 cases, two were positive for HSV-1 antigen in CSF and one in brain tissue by DIF. Virus specific IgG antibody in paired CSF and serum samples was positive in one case only. In none, virus could be grown in verocell line. In 2 Patients antemortem diagnosis was possible and parenteral acyclovir could be administered in one case that recovered following treatment. Thus, besides antibody detection, direct immunofluorescence is an useful and rapid method for the early diagnosis of HSE.