Tr抗体介导的小脑性共济失调一例并文献复习

Cerebellar ataxia associated with anti-Tr antibodies:A case report and literature review

目的探讨Tr抗体介导的小脑性共济失调患者的临床特点。方法报告1例Tr抗体介导的小脑性共济失调患者的临床特点及随访情况。结果患者为49岁男性,隐匿起病,主要表现为2个月内逐渐进展的小脑性共济失调。既往史无特殊。实验室检查:脑脊液白细胞计数50×106/L,蛋白49 mg/dL;血清Tr抗体强阳性(+++),脑脊液Tr抗体弱阳性(+)。MRI上无小脑结构性改变,PET/CT可见双侧小脑葡萄糖代谢轻度减低。经系统排查,未发现肿瘤。先后予以糖皮质激素、静脉注射人免疫球蛋白(intravenous immunoglobulin,IVIG)治疗后,患者症状稍有缓解,脑脊液白细胞计数下降至7×106/L,蛋白下降至24 mg/dL,血清Tr抗体转为阴性。结论本例患者主要表现为进展型共济失调,脑脊液细胞数和蛋白水平轻度升高,血清和脑脊液Tr抗体均阳性,PET/CT可见双侧小脑葡萄糖代谢轻度减低,免疫治疗有效,但未查及肿瘤,在随访中应继续关注。

Objective To investigate the clinical characteristics of cerebellar ataxia associated with anti-Tr antibodies.Methods We present the clinical feature and the follow-up result of a patient with cerebellar ataxia associated with anti-Tr antibodies.Results A 49-year-old male presented with a 2-month history of cerebellar ataxia with insidious onset and progressive course.His past history was clear.Cerebrospinal fluid(CSF)analysis revealed mild pleocytosis(50×106/L)and a slight increase in protein content(49 mg/dL).Anti-Tr antibodies were detected as strong-positive in serum and weak-positive in cerebrospinal fluid.The magnetic resonance imaging showed normal structure of the cerebellum.But brain fluorodeoxyglucose positron emission tomography(PET)showed cerebellar hypometabolism.We didn’t find any tumor after systemic examinations.After steroids and intravenous immunoglobulin treatment,he got mild relief.The cerebrospinal fluid showed that white blood cells were 7×106/L,and protein 24 mg/dL.His serum was tested negative for anti-Tr antibody.Conclusions The male patient presented with progressive ataxia.CSF analysis showed a mild increase in cell counts and protein levels.Serum and CSF showed Tr antibodies.And PET revealed cerebellar hypometabolism.His symptoms were improved after immunotherapy.But no tumor was found in this case.Screening for tumors should be carried out.