抗N-甲基-D-天门冬氨酸受体脑炎发病机制的研究进展

Research advances in pathogenesis of anti-N-methyl-D-aspartate receptor encephalitis

抗N-甲基-D-天门冬氨酸受体(NMDAR)脑炎已经成为脑炎疾病当中最主要的类型。阐明抗NMDAR脑炎的发病机制对于理解该病,进而进行合理的治疗是非常有必要的。该文从以下几个方面进行综述:(1)抗NMDAR脑炎发病与肿瘤关系的发现;(2)抗NMDAR脑炎与肿瘤关系的进一步研究;(3)抗NMDAR抗体识别的抗原决定部位,患者的自身免疫反应;(4)抗体与受体的作用:(5)不伴有肿瘤的抗NMDAR脑炎的发病机制。该文向读者展示了这个病从在临床中被发现,到认识它和肿瘤的关系,再到从病理组织、分子水平以及信号传导水平进行研究的过程。展现一个科研思路,告诉读者临床医生是如何在临床中发现问题并逐步深入解决问题。目前的研究已证明抗NMDAR脑炎是一种和肿瘤尤其是卵巢畸胎瘤密切相关的神经系统自身免疫性疾病。

Anti-N-methyl-D-aspartate receptor（NMDAR） encephalitis is the most prevalent type of encephalitis.Investigating the pathogenesis of anti-NMDAR encephalitis will enhance our understanding of this disease and play a central part in providing reasonable treatment for the patients.The pathogenesis is elucidated as follows：（1） the findings of the relationship between anti-NMDAR encephalitis and tumors;（2） further research on the relationship between anti-NMDAR encephalitis and tumors;（3） NMDAR epitopes and the autoimmunity of patients;（4） the interaction between antibody and NMDAR;（5） the pathogenesis of anti-NMDAR encephalitis without tumors.This review gives a brief introduction to the methodology and way of finding out the valuable clinical problems and making a clear and explicit explanation of them by exhibiting the process of discovering the disease,disclosing its relationship with tumors,and investigating its pathological and molecular mechanism.Current studies have demonstrated that anti-NMDAR encephalitis is an autoimmune disease of the nervous system that is closely associated with tumors,particularly ovarian teratoma.[Chin J Contemp Pediatr,2014,16（6）： 571-574]