[1]梁妍 王静 杨光.儿童抗MOG抗体及抗NMDAR抗体双阳性中枢神经系统脱髓鞘1例报道并文献复习[J].卒中与神经疾病杂志,2020,27(02):216-220.[doi:10.3969/j.issn.1007-0478.2020.02.017]
　Liang Yan,Wang Jing,Yang Guang..The demyelination of central nervous system with anti-MOG antibody and anti-NMDAR antibody in children: a case report and literature review[J].Stroke and Nervous Diseases,2020,27(02):216-220.[doi:10.3969/j.issn.1007-0478.2020.02.017]
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儿童抗MOG抗体及抗NMDAR抗体双阳性中枢神经系统脱髓鞘1例报道并文献复习()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第27卷
期数:
2020年02期
页码:
216-220
栏目:
论 著
出版日期:
2020-03-15

文章信息/Info

Title:
The demyelination of central nervous system with anti-MOG antibody and anti-NMDAR antibody in children: a case report and literature review
文章编号:
1007-0478(2020)02-0216-05
作者:
梁妍 王静 杨光
100853 北京,中国人民解放军总医院第一医学中心儿内科[梁妍 王静 杨光(通信作者
Author(s):
Liang Yan;  Wang Jing;  Yang Guang.
Department of Pediatrics, First Medical Center, PLA General Hospital, Beijing 100853
关键词:
缺血性脑卒中 睡眠呼吸紊乱 病灶 影响因素
Keywords:
Anti-MOG antibody Anti-NMDA receptor antibody Central nervous system demyelinating diseases Children
分类号:
R744.5
DOI:
10.3969/j.issn.1007-0478.2020.02.017
文献标志码:
A
摘要:
目的 探讨缺血性脑卒中(Cerebral ischemic stroke,CIS)患者发生睡眠呼吸紊乱(Sleep-disordered breathing,SDB)的影响因素。方法 纳入2018年2月-2019年4月本院神经内科收治的288例首次发病的CIS患者,于发病后的第7 d左右采用Apnea LinkTM睡眠测试装置整夜连续进行呼吸睡眠检测,发生SDB的患者[呼吸暂停-低通气指数(Apnoea-hypopnoea index,AHI)≥10]纳入研究组,未发生SDB的患者纳入对照组,考察CIS患者中SDB的发生率,采用单因素分析的方法比较发生SDB的可疑危险因素,对于单因素分析有意义的自变量,采用Logistic回归逐步向前法进一步识别SDB的独立影响因素。结果 CIS患者中SDB的发病率为63.1%。多因素Logistic回归分析显示,年龄≥65岁[OR(95%CI)=2.078(1.317～3.28),P=0.002]、脑干病变[OR(95%CI)=2.306(1.418～3.75),P=0.001]、NIHSS得分[OR(95%CI)=2.368(1.34～4.185),P=0.003]、mRS得分[OR(95%CI)=2.033(1.146～3.606),P=0.015]和发生吞咽困难[OR(95%CI)=2.392(1.031～5.545),P=0.042]是脑卒中患者发生SDB的独立危险因素。结论 脑干损伤是脑卒中患者发生SDB的主要危险因素,而SDB加重了急性期缺血性脑卒中患者的神经系统症状,老年缺血性脑卒中患者是SDB的易感人群。对脑干损伤的老年患者,要重视早期监测呼吸睡眠功能,发生SDB迹象时要及时采取干预措施。
Abstract:
ObjectiveTo investigate the clinical and imaging characteristics of central nervous system(CNS)demyelinating diseases with both anti-MOG and anti-NMDAR antibodies positive in children.Methods The clinical and imaging features of a child with both anti-MOG antibody and anti-NMDAR antibody positive were analyzed. The published papers were browsed by using “anti-MOG antibody”, “anti-NMDAR antibody” and “demyelinating” as key words in Wanfang, CNKI and PubMed database from starting point to February 2019.Results The main clinical manifestation of the patient was acute disseminated encephalomyelitis(ADEM). And her brain MRI showed multiple abnormal signals in bilateral cerebellar hemisphere, brainstem, bilateral pontobrachium, bilateral thalamus, bilateral frontal-parietal lobe, cervical and thoracic spinal cord. A total of 5 articles reported 12 cases with anti-MOG antibody and anti-NMDAR antibody positive, and nearly half of them had emotional changes, aphasia, epilepsy or optic neuritis. Except for 3 children with no abnormal cranial MRI, the other 9 children with T2 or FLAIR showed multiple intracranial high signals, which could be found in frontal lobe, temporal lobe, parietal lobe, basal ganglia and cerebellum.Conclusion Patients suspected for CNS demyelinating diseases should be tested autoimmune encephalitis-related antibodies and central nervous system demyelinating disease-related antibodies with serum and cerebrospinal fluid in order to formulate the best treatment plan to reduce recurrence.

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备注/Memo

备注/Memo:
国家自然科学基金面上项目(编号81671279); 国家重点研发计划(编号SQ2018YFC100110)(2019-07-29收稿)
更新日期/Last Update: 2020-03-15