发作性睡病免疫学机制

发作性睡病是一种严重的睡眠障碍，其中猝倒型患者下丘脑大量 Hypoeretin （ Hcrt）/Orexin能神经元缺失可能是自身免疫性因素选择性破坏下丘脑Hcrt能神经元所致。流行病学调查资料显示，发作性睡病发病率升高与甲型H1N1流感病毒感染、疫苗接种、化脓性链球菌感染密切相关；而且遗传闲素（（HLA-DOB1＊0602、P2RY11基囚多态性）和自身免疫性因素（TCR-α基因多态性、肿瘤坏死因子-α）亦参与其中。大剂量静脉滴注免疫球蛋白可暂时改善猝倒发作症状，但针对下丘脑Hcrt能神经元自身抗体或T细胞反应的治疗措施尚无确凿证据。随着对发作性睡病病因学研究的深入，其免疫学研究将是未来的热点领域。

Research progress of immunologic mechanism of narcolepsy

Narcolepsy is a severe neurological sleep disorder, which is caused by the large loss of Hypocretin （Hcrt）/Orexin producing neurons in the hypothalamus in narcolepsy with cataplexy patients. It is likely the result of an autoirnmune process that causes selective destruction of Hcrt neurons in the hypothalamus. It has been known that narcolepsy is associated with the human leukocyte antigens （HLA）- DR2 and HLA- DQBI＊0602. Recent epidemic data have shown a robust incidence of disease onset associated with pandemic H1N1-infection, H1N1 vaccination and streptococcus pyogenes infection. A genome-wide association variants in P2RYll are associated with narcolepsy. Narcolepsy is associated with polymorphisms of the genes encoding T cell receptor-α （TCR-α） and tumor necrosis factor-α （TNF-α）.Several cases report successful management of cataplexy with intravenous immunoglobulins at narcolepsy onset, but the effects are not persistent. However, there is no significant evidence of narcolepsy specific antibodies or T cell reactions found, and the relations with cytokines and central nervous system inflammatory cells have not been elaborated well. It is still a big challenge for further study.