抗CASPR2抗体相关自身免疫性脑炎的临床分析

Clinical analysis of anti-CASPR2 antibody associated autoimmune encephalitis

目的探讨抗接触蛋白相关蛋白-2(CASPR2)抗体相关自身免疫性脑炎的临床特征及治疗。方法选取2017年3月至2020年12月在郑州市第三人民医院和河南中医药大学第一附属医院确诊的5例抗CASPR2抗体相关自身免疫性脑炎患者临床资料进行回顾性分析。结果5例患者中男3例,1例患者发病前有发热病史,2例表现为精神行为异常、2例患者以癫痫为首发症状、1例患者表现为记忆力下降,合并神经疼痛基础上存在失眠者1例、合并小脑症状同时存在失眠者1例,合并自主神经功能障碍者2例。5例患者血清抗CASPR2抗体均为阳性,1例患者脑脊液抗CASPR2抗体呈阳性,所有患者均接受免疫治疗,治疗有效。结论抗CASPR2抗体相关自身免疫性脑炎可累及中枢神经系统、外周神经系统、自主神经系统等多系统从而引起多变临床综合征,免疫治疗有效。

Objective To investigate the clinical features and treatment of anti-contactin associated protein-like 2(CASPR2)antibody associated autoimmune encephalitis.Methods Clinical data of five cases of anti-CASPR2 antibody associated autoimmune encephalitis diagnosed in the Third People’s Hospital of Zhengzhou and the First Affiliated Hospital of Henan University of Chinese Medicine from March 2017 to December 2020 were retrospectively analyzed.Results Among the five patients,there were three male patients,one patient had a history of fever before onset,two patients showed abnormal mental behavior,two patients showed epilepsy as the first symptom,and one patient showed memory loss.One patient had insomnia based on nerve pain,one patient had insomnia combined with cerebellar symptoms,and two patient had autonomic nerve dysfunction.Serum anti-CASPR2 antibody was positive in five patients,and cerebrospinal fluid anti-CASPR2 antibody was positive in one patient.All patients received immunotherapy,and the treatment was effective.Conclusion Anti-CASPR2 antibody associated autoimmune encephalitis may involve the central nervous system,the peripheral nervous system,the autonomic nervous system and other systems,leading to variable clinical syndrome,and immunotherapy is effective.