自身免疫性脑炎患儿免疫水平的变化

发布时间：2018-05-21 00:15

  本文选题：自身免疫性脑炎 + 边缘性脑炎　； 参考：《河北医科大学》2014年硕士论文

【摘要】：目的：自身免疫性脑炎泛指一大类由于免疫系统针对中枢神经系统抗原产生反应而导致的疾病，并且逐渐被认为是非感染因素所致可逆转性脑炎的重要原因。自从20世纪60年代开始，国内外学者发现多种与之有关的自身抗体，如：抗Hu抗体、抗Ta/Ma2抗体、抗电压门控性钾离子通道（VGKC）抗体、抗N-甲基-D-天门冬氨酸受体（NMDAR）抗体、抗谷氨酸脱氢酶（GAD）抗体、抗甲状腺抗体等与之相关，但其发病机制尚不明确。神经病理学研究显示，自身免疫性脑炎的病理改变以脑实质内T细胞的浸润为主，故推测自身免疫性脑炎是由T细胞介导引起的一种免疫性疾病。通过对自身免疫性脑炎患儿CD3、CD4、CD8、CD54、IgA、IgG、IgM、抗NMDAR抗体、抗GAD抗体的检测，分析患儿免疫水平变化，并为进一步探索发病机制提供方向，也对临床疾病的诊断、治疗提供理论依据。 方法：本研究属于开放性病例对照研究。 选取2012年12月至2013年12月就诊于河北省儿童医院神经内科病房的34例诊断自身免疫性脑炎患儿作为病例组，，由小儿神经内科专家根据临床表现、脑脊液检查、脑电图及头颅MRI确定诊断，诊断标准参照2004年神经系统副肿瘤综合征欧洲工作网诊断标准。入组必需满足3个条件：①有癫痫发作或精神异常等临床表现；②脑脊液白细胞高于正常或脑电图可见高幅慢波；③头颅MRI检查可见脑实质浸润改变。正常对照组共选择了36人，选自研究期间河北省儿童医院儿童保健科的健康体检患儿。 所有入组的儿童均于晨起空腹采集3-4ml分离胶促凝静脉血和1mlEDTA-K2抗凝静脉血，使用全自动生化分析仪（日立7060全自动生化分析仪），采用免疫比浊法检测血清中免疫球蛋白IgA、IgG及IgM；使用流式细胞分析仪（美国BECKMAN COULTER公司生产，型号Epics XL）检测血清中的CD3、CD4、CD8及CD54；所有入组儿童还要留取2-3ml分离胶促凝静脉血置于干净密闭的专用试管内，离心后采集上清液，采用酶联免疫吸附法测定抗NMDAR抗体及抗GAD抗体；此外病例组儿童采集1ml脑脊液置于干净密闭的专用试管内，离心后采集上清液，采用酶联免疫吸附法检测抗NMDAR抗体及抗GAD抗体。购买由上海沪宇生物公司提供的人抗GAD-Ab ELISA检测试剂盒和人抗NMDAR-Ab酶联免疫分析试剂盒。 对所有数据进行整理、汇总并应用SPSS13.0进行统计学分析，以P0.05作为检验水准。 结果： 1病例组患儿血IgA值高于正常对照组，差异具有显著的统计学意义P0.05； 2病例组患儿血IgM值高于正常对照组，差异具有显著的统计学意义P0.05； 3病例组患儿血IgG值高于正常对照组，差异具有显著的统计学意义P0.05； 4病例组患儿血CD3值低于正常对照组，差异具有显著的统计学意义P0.05； 5病例组患儿血CD4值低于正常对照组，差异具有显著的统计学意义P0.05； 6病例组患儿血CD8值与正常对照组比较无显著性差异P0.05； 7病例组患儿血CD54值与正常对照组比较无显著性差异P0.05； 8病例组患儿脑脊液抗GAD抗体、血清抗GAD抗体均阴性；对照组血清GAD抗体均阴性； 9病例组各患儿脑脊液抗NMDAR抗体、血清抗NMDAR抗体均阴性；对照组血清NMDAR抗体均阴性。 结论： 自身免疫性脑炎患儿存在细胞免疫及体液免疫功能紊乱，主要表现为血液中CD3、CD4含量降低，IgA、IgG、IgM含量升高，CD8、CD54含量基本正常；提示细胞免疫、体液免疫可能均参与致病过程，自身免疫性脑炎的发病与机体神经-内分泌-免疫网络的功能紊乱存在密不可分的关系。检测自身免疫性脑炎患儿血和脑脊液抗GAD抗体、抗NMDAR抗体均阴性，提示这两种自身抗体并非致病的必要因素，但由于实验条件所限，并未检测所有可能存在的自身抗体，故并不能排除其他自身抗体存在的可能性。总之，在临床中遇到自身免疫性脑炎患儿，在对症治疗的同时关注其细胞免疫及体液免疫功能的变化，并针对其变化应用调节自身免疫的药物，对于疾病的治疗可能有所裨益，对于疾病预后起到改善作用；此外，根据细胞、体液免疫指标的变化，对于自身免疫性脑炎诊断有一定指导作用。
[Abstract]:Objective: autoimmune encephalitis refers to a large class of diseases caused by the immune system's response to the central nervous system antigen, and is gradually considered to be an important cause of reversible encephalitis caused by non infectious factors. Since 1960s, many domestic and foreign scholars have developed a variety of related autoantibodies, such as anti Hu. Antibody, anti Ta/Ma2 antibody, anti voltage gated potassium ion channel (VGKC) antibody, anti N- methyl -D- aspartic acid receptor (NMDAR) antibody, anti glutamic dehydrogenase (GAD) antibody, anti thyroid antibody and so on, but its pathogenesis is not clear. Neuropathological study shows that the pathological changes of autoimmune encephalitis are T fine in the brain parenchyma. It is suggested that autoimmune encephalitis is an immune disease induced by T cells. Through the detection of CD3, CD4, CD8, CD54, IgA, IgG, IgM, anti NMDAR antibody and anti GAD antibody in children with autoimmune encephalitis, it analyses the changes in the immune level of children and provides direction for further exploration of the pathogenesis, and also to clinical diseases. Diagnosis and treatment provide a theoretical basis.
Methods: This study is an open case-control study.
34 children with autoimmune encephalitis diagnosed in the neurology ward of Hebei children's Hospital from December 2012 to December 2013 were selected as a case group. The diagnostic criteria were based on the clinical manifestations, cerebrospinal fluid examination, electroencephalogram and head MRI, and the diagnostic criteria refer to the European workers of the 2004 paraneoplastic syndrome. 3 conditions must be met: (1) the clinical manifestations of epileptic seizures or mental abnormalities; (2) the white blood cells in the cerebrospinal fluid were higher than normal or electroencephalogram, and high amplitude slow waves were seen in the brain; (3) the head MRI examination showed the changes of the brain parenchyma infiltration. The normal control group selected 36 people from the children's Hospital of Hebei Province during the study period. Children in the Department of health examination.
All the children in the group were collected on the empty stomach to collect 3-4ml coagulant blood and 1mlEDTA-K2 anticoagulant blood on the morning, using an automatic biochemical analyzer (Hitachi 7060 automatic biochemical analyzer), immuno turbidimetry was used to detect the serum immunoglobulin IgA, IgG and IgM, and the flow cytometry (American BECKMAN COULTER company) was used. Model Epics XL) detection of CD3, CD4, CD8 and CD54 in serum; all the children in the group should be left with 2-3ml separation glue to put the vein blood in a clean and closed special test tube, collect the supernatant after centrifugation and determine the anti NMDAR antibody and anti GAD antibody by enzyme linked immunosorbent assay. The children of this case group collected 1ml cerebrospinal fluid in a clean airtight seal. In the special test tube, the supernatant was collected after centrifugation, the anti NMDAR antibody and the anti GAD antibody were detected by enzyme linked immunosorbent assay. The anti GAD-Ab ELISA detection kit and the human anti NMDAR-Ab immunoassay kit provided by Shanghai Hu Yu biological company were purchased.
All data were sorted, summarized and applied to SPSS13.0 for statistical analysis, with P0.05 as the testing standard.
Result锛

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