血清阳性和血清阴性自身免疫性脑炎的临床、诊断和治疗范围:51 个病例的单中心队列研究和文献综述

Q4 Immunology and Microbiology
Ahmed Elrefaey, Ahmed Mohamedelkhair, Lara Fahmy, Mohammad Affan, Lonni R. Schultz, M. Cerghet, A. Memon
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引用次数: 0

摘要

自身免疫性脑炎(AE)由一系列炎症性神经综合征组成,其特点是对神经元自身抗原的免疫反应,导致多种临床表现,尤其是行为和认知能力下降。这项单中心回顾性研究纳入了密歇根州东南部一家三级甲等医院 2013 年至 2019 年期间确诊的 51 例 AE 患者。然后,根据血清、脑脊液或两者中的抗体检测结果,将患者分为血清阳性 AE(AE+)和血清阴性 AE(AE-)两组。该研究比较了 AE+ 和 AE- 亚型在临床、诊断和治疗参数方面的差异。共有 34 名患者被归类为 AE+,17 名被归类为 AE-。人口统计学分析显示,两组患者在年龄、性别或种族方面无明显差异。临床表现差异很大,包括精神症状、运动障碍、癫痫发作和精神错乱;24%的患者曾患恶性肿瘤。实验室评估在 AE+ 患者的血清中发现了多种自身抗体。放射学和电生理学评估显示,两组之间没有明显差异。与 AE+ 患者相比,AE- 患者出现意识模糊的比例更高(59% vs. 18%,P = 0.004)。这项研究的重点是与 AE 诊断相关的复杂性,强调了症状的异质性和抗体检测结果经常呈阴性所带来的挑战。无论血清阳性还是阴性,快速识别 AE 对临床医生来说都是一个关键因素,有助于在必要时迅速启动免疫疗法和/或肿瘤切除术。这些见解有助于更好地了解这种疾病的全貌,为临床医生提供了完善诊断和治疗策略的工具。最终,该研究旨在加强对AE的管理,使医护人员能够准确、及时地对患者进行干预。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The clinical, diagnostic and treatment spectrum of seropositive and seronegative autoimmune encephalitis: Single‐center cohort study of 51 cases and review of the literature
Autoimmune encephalitis (AE) comprises a spectrum of inflammatory neurological syndromes characterized by immune responses to neuronal autoantigens, leading to diverse clinical manifestations, particularly behavioral and cognitive decline.This single‐center retrospective study included 51 patients diagnosed with AE from 2013 to 2019 in a southeast Michigan tertiary care hospital. Patients were then divided into two groups, seropositive AE (AE+) and seronegative AE (AE−), based on antibody detection in the serum, cerebrospinal fluid or both when available. The study compares AE+ and AE− subtypes across clinical, diagnostic, and therapeutic parameters.A total of 34 patients were classified as AE+, and 17 as AE−. Demographic analysis showed no significant differences in age, sex or race between the two groups. Clinical presentations varied widely, encompassing psychiatric symptoms, movement disorders, seizures and confusion; 24% patients had a prior malignancy. Laboratory assessments found diverse autoantibodies in AE+ patients' serum. Radiological and electrophysiological assessments showed no significant differences between the groups. AE− patients had higher rates of confusion compared with AE+ patients (59% vs. 18%, P = 0.004).This study focuses on the complexities associated with diagnosing AE, emphasizing the challenges posed by the heterogeneity of symptoms and often negative antibody test results. Rapid identification of AE, regardless of seropositivity or seronegativity, emerges as a critical factor for clinicians, facilitating the prompt initiation of immunotherapy and/or tumor removal if needed. These insights contribute to a better understanding of the landscape of this condition, offering clinicians the tools to refine their diagnostic and treatment strategies. Ultimately, the study aimed to enhance the management of AE, empowering healthcare professionals to make accurate and timely interventions for patients.
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来源期刊
Clinical and Experimental Neuroimmunology
Clinical and Experimental Neuroimmunology Immunology and Microbiology-Immunology and Microbiology (miscellaneous)
CiteScore
1.60
自引率
0.00%
发文量
52
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