儿童抗MOG抗体合并抗NMDAR抗体双阳性自身免疫性脑炎2例并文献复习

目的 探讨儿童抗髓鞘少突胶质细胞糖蛋白(myelin oligodendrocyte glycoprotein,MOG)抗体合并抗N-甲基-D-门冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)抗体双阳性自身免疫性脑炎的临床特点。方法 回顾性分析邯郸市中心医院收治的2例抗MOG抗体合并抗NMDAR抗体双阳性自身免疫性脑炎患儿的病例资料,并复习相关文献。结果 2例脑脊液白细胞数目均增多,1例颅脑磁共振成像(magnetic resonance imaging,MRI)同时存在幕上及幕下病变,1例仅有幕上病变且其视频脑电图结果与抗NMDAR脑炎典型脑电图相似。经甲泼尼龙冲击、人免疫球蛋白治疗后,2例症状均得到改善,3个月后随访,均无复发。结论 该病多发于青少年,既有抗MOG抗体相关疾病的脑病表现,也有抗NMDAR脑炎的表现,且以抗NMDAR脑炎的表现更易被识别。颅脑MRI及视频脑电图等无创检查对此病诊断有一定提示意义,但确诊仍需神经抗体检查,诊疗方面一线治疗为激素、免疫球蛋白、血浆置换,多数患儿对此治疗反应良好,但发病机制仍需进一步研究。

Two cases of children's anti-MOG antibodies combined with anti-NMDAR antibody double positive autoimmune encephalitis and literature review

Objective To explore clinical features of double-positive autoimmune encephalitis of children's anti-myelin oligodendrocyte glycoprotein (MOG) antibodies complicated with anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. Methods The case data of 2 children with anti-MOG antibodies combined with anti-NMDAR antibody double-positive autoimmune encephalitis admitted to Handan Central Hospital were retrospectively analyzed, and the relevant literature was reviewed. Results The number of leukocytes in cerebrospinal fluid increased in 2 cases, both supratentorial and infratentorial lesions were found in the head magnetic resonance imaging (MRI) of one case, one case was found to have supratentorial lesions only, and the video electroencephalogram outcome was similar to that of anti-NMDAR encephalitis. The symptoms of both two cases were improved after being treated with methylprednisolone and human immunoglobulin, and no recurrence was found with either case after 3 months of follow-up. Conclusion The disease is more common in adolescents, both encephalopathic manifestations of anti-MOG antibody-related diseases and anti-NMDAR encephalitis are noted, and the manifestations of anti-NMDAR encephalitis are also noted. Noninvasive examinations including cranial MRI and video electroencephalogram show certain indications, and neuroantibody examination becomes necessary for confirmation. The first-line therapies involve the hormone, immunoglobulin and plasma exchange. Most children respond well to the above therapies, while the pathogenesis remains further study.