摘要
目的观察3例罕见的髓鞘少突胶质细胞糖蛋白(MOG)抗体相关疾病和抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎重叠综合征(MNOS)患者的临床表现,旨在拓宽对此类综合征临床谱的认识。方法回顾性分析MOG抗体和NMDAR抗体双阳性的3例MNOS患者的资料,收集患者临床特征、神经影像学特征及转归,采用基于细胞转染的间接免疫荧光法(CBA)进行诊断。结果1例同时出现MOG抗体和NMDAR抗体阳性,但临床表现为典型的抗NMDAR脑炎症状;1例为继抗NMDAR脑炎后复发出现脱髓鞘疾病的临床和头颅磁共振成像(MRI)特征,复发时表现为肢体麻木无力、视物模糊、复视等MNOS非典型症状;1例同时出现MOG抗体和NMDAR抗体阳性,但临床表现为典型的抗NMDAR脑炎症状。在MNOS中,MOG抗体相关疾病和抗NMDAR脑炎可同时出现,也可先后出现,癫痫为其最常见的症状;头颅MRI显示患者均存在且主要为幕上病灶,也可累及脑干,未见脊髓病灶,脑脊液均轻度异常。患者发病急性期对一线免疫治疗反应良好,预后较好,但多数患者易复发。结论MNOS患者中抗NMDAR脑炎可同时或相继出现脱髓鞘疾病的临床和/或MRI特征,患者临床表现复杂且多样。对于存在不典型的症状的患者,要求提高对MNOS的认识,并及时治疗。
Objective To observe the clinical manifestations of 3 cases with myelin oligodendrocyte glycoprotein(MOG)antibody-associated disease and anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis antibody overlapping syndrome(MNOS),aiming to expand the understanding of the clinical spectrum of such syndromes.Methods Retrospective analysis was performed on the data of 3 patients with MNOS who were positive for both MOG antibodies and NMDAR antibodies.Clinical features,neuroimaging characteristics,and outcomes were collected,and cell-based assay(CBA)technique was used for diagnosis.Results One case presented both positive MOG antibodies and NMDAR antibodies,but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis.In one case,the clinical and cranial magnetic resonance imaging(MRI)features of demyelinating disease recurred after anti-NMDAR encephalitis,with atypical symptoms of MNOS such as numbness and weakness in limbs,blurred vision,and diplopia.The last case presented both positive MOG antibodies and NMDAR antibodies,but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis.In MNOS,MOG antibody-associated disease and anti-NMDAR encephalitis may appear simultaneously or sequentially,with epilepsy being the most common symptom.Cranial MRI findings showed that the patients presented and mainly involved supratentorial lesions,which may also involve the brainstem,but no spinal cord lesions were found.All patients showed slightly abnormal cerebrospinal fluid.Patients showed a good response to first-line immunotherapy during the acute phase of the disease,with a favorable prognosis.But most patients were prone to relapse.Conclusion In MNOS patients,anti-NMDAR encephalitis may present with clinical and(or)MRI features of demyelinating disease simultaneously or sequentially.The clinical manifestations of patients are complex and diverse.Patients with atypical symptoms require to improving the understanding of MNOS and timely treatment.
作者
朱琳
蒋
俞龙
吴健
殷梦媚
黄君文
马灿灿
ZHU Lin;JIANG Li;YU Long;WU Jian;YIN Mengmei;HUANG Junwen;MA Cancan(Department of Neurology,School of Clinical Medicine of Yangzhou University,Subei People′s Hospital Affiliated to Yangzhou University,Yangzhou,Jiangsu,225000;Department of Geriatrics,School of Clinical Medicine of Yangzhou University,Subei People′s Hospital Affiliated to Yangzhou University,Yangzhou,Jiangsu,225000;Department of Imaging,School of Clinical Medicine of Yangzhou University,Subei People′s Hospital Affiliated to Yangzhou University,Yangzhou,Jiangsu,225000)
出处
《实用临床医药杂志》
CAS
2024年第2期49-54,59,共7页
Journal of Clinical Medicine in Practice
