本文選題：自身免疫性腦炎 + 邊緣性腦炎��； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：自身免疫性腦炎泛指一大類由于免疫系統(tǒng)針對中樞神經(jīng)系統(tǒng)抗原產(chǎn)生反應(yīng)而導(dǎo)致的疾病，并且逐漸被認(rèn)為是非感染因素所致可逆轉(zhuǎn)性腦炎的重要原因。自從20世紀(jì)60年代開始，國內(nèi)外學(xué)者發(fā)現(xiàn)多種與之有關(guān)的自身抗體，如：抗Hu抗體、抗Ta/Ma2抗體、抗電壓門控性鉀離子通道（VGKC）抗體、抗N-甲基-D-天門冬氨酸受體（NMDAR）抗體、抗谷氨酸脫氫酶（GAD）抗體、抗甲狀腺抗體等與之相關(guān)，但其發(fā)病機制尚不明確。神經(jīng)病理學(xué)研究顯示，自身免疫性腦炎的病理改變以腦實質(zhì)內(nèi)T細(xì)胞的浸潤為主，故推測自身免疫性腦炎是由T細(xì)胞介導(dǎo)引起的一種免疫性疾病。通過對自身免疫性腦炎患兒CD3、CD4、CD8、CD54、IgA、IgG、IgM、抗NMDAR抗體、抗GAD抗體的檢測，分析患兒免疫水平變化，并為進一步探索發(fā)病機制提供方向，也對臨床疾病的診斷、治療提供理論依據(jù)。 方法：本研究屬于開放性病例對照研究。 選取2012年12月至2013年12月就診于河北省兒童醫(yī)院神經(jīng)內(nèi)科病房的34例診斷自身免疫性腦炎患兒作為病例組，，由小兒神經(jīng)內(nèi)科專家根據(jù)臨床表現(xiàn)、腦脊液檢查、腦電圖及頭顱MRI確定診斷，診斷標(biāo)準(zhǔn)參照2004年神經(jīng)系統(tǒng)副腫瘤綜合征歐洲工作網(wǎng)診斷標(biāo)準(zhǔn)。入組必需滿足3個條件：①有癲癇發(fā)作或精神異常等臨床表現(xiàn)；②腦脊液白細(xì)胞高于正�；蚰X電圖可見高幅慢波；③頭顱MRI檢查可見腦實質(zhì)浸潤改變。正常對照組共選擇了36人，選自研究期間河北省兒童醫(yī)院兒童保健科的健康體檢患兒。 所有入組的兒童均于晨起空腹采集3-4ml分離膠促凝靜脈血和1mlEDTA-K2抗凝靜脈血，使用全自動生化分析儀（日立7060全自動生化分析儀），采用免疫比濁法檢測血清中免疫球蛋白IgA、IgG及IgM；使用流式細(xì)胞分析儀（美國BECKMAN COULTER公司生產(chǎn)，型號Epics XL）檢測血清中的CD3、CD4、CD8及CD54；所有入組兒童還要留取2-3ml分離膠促凝靜脈血置于干凈密閉的專用試管內(nèi)，離心后采集上清液，采用酶聯(lián)免疫吸附法測定抗NMDAR抗體及抗GAD抗體；此外病例組兒童采集1ml腦脊液置于干凈密閉的專用試管內(nèi)，離心后采集上清液，采用酶聯(lián)免疫吸附法檢測抗NMDAR抗體及抗GAD抗體。購買由上海滬宇生物公司提供的人抗GAD-Ab ELISA檢測試劑盒和人抗NMDAR-Ab酶聯(lián)免疫分析試劑盒。 對所有數(shù)據(jù)進行整理、匯總并應(yīng)用SPSS13.0進行統(tǒng)計學(xué)分析，以P0.05作為檢驗水準(zhǔn)。 結(jié)果： 1病例組患兒血IgA值高于正常對照組，差異具有顯著的統(tǒng)計學(xué)意義P0.05； 2病例組患兒血IgM值高于正常對照組，差異具有顯著的統(tǒng)計學(xué)意義P0.05； 3病例組患兒血IgG值高于正常對照組，差異具有顯著的統(tǒng)計學(xué)意義P0.05； 4病例組患兒血CD3值低于正常對照組，差異具有顯著的統(tǒng)計學(xué)意義P0.05； 5病例組患兒血CD4值低于正常對照組，差異具有顯著的統(tǒng)計學(xué)意義P0.05； 6病例組患兒血CD8值與正常對照組比較無顯著性差異P0.05； 7病例組患兒血CD54值與正常對照組比較無顯著性差異P0.05； 8病例組患兒腦脊液抗GAD抗體、血清抗GAD抗體均陰性；對照組血清GAD抗體均陰性； 9病例組各患兒腦脊液抗NMDAR抗體、血清抗NMDAR抗體均陰性；對照組血清NMDAR抗體均陰性。 結(jié)論： 自身免疫性腦炎患兒存在細(xì)胞免疫及體液免疫功能紊亂，主要表現(xiàn)為血液中CD3、CD4含量降低，IgA、IgG、IgM含量升高，CD8、CD54含量基本正常；提示細(xì)胞免疫、體液免疫可能均參與致病過程，自身免疫性腦炎的發(fā)病與機體神經(jīng)-內(nèi)分泌-免疫網(wǎng)絡(luò)的功能紊亂存在密不可分的關(guān)系。檢測自身免疫性腦炎患兒血和腦脊液抗GAD抗體、抗NMDAR抗體均陰性，提示這兩種自身抗體并非致病的必要因素，但由于實驗條件所限，并未檢測所有可能存在的自身抗體，故并不能排除其他自身抗體存在的可能性�？傊�，在臨床中遇到自身免疫性腦炎患兒，在對癥治療的同時關(guān)注其細(xì)胞免疫及體液免疫功能的變化，并針對其變化應(yīng)用調(diào)節(jié)自身免疫的藥物，對于疾病的治療可能有所裨益，對于疾病預(yù)后起到改善作用；此外，根據(jù)細(xì)胞、體液免疫指標(biāo)的變化，對于自身免疫性腦炎診斷有一定指導(dǎo)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錛

本文編號：1916872