表现为头痛和视力障碍的抗GQ1b抗体综合征一例并文献复习

Anti-GQ1b antibody syndrome presenting with headache and visual disturbance:a case report and literature review

目的分析和总结出现头痛和视力障碍罕见非典型表现的抗GQ1b抗体综合征患者的临床特征。方法报道1例出现头痛和视力障碍罕见非典型表现的抗GQ1b抗体综合征患者的临床资料,并以中文检索词“视力障碍”“视力损伤”“头痛”“头疼”,英文检索词“GQ1b”“vision disorders”“visual disorders”“visual disturbance”“headache”“head pain”“cephalalgia”等在PubMed、Web of Science、CNKI、万方数据知识服务平台检索公开发表的文献。结合文献对该类患者的发病机制、临床表现、实验室及辅助检查、治疗及预后做总结。结果该例患者为71岁男性,发病3周前有腹泻病史,表现为头痛和视力障碍,脑脊液抗GQ1b抗体(+),抗水通道蛋白4(AQP-4)抗体(-),诊断为抗GQ1b抗体综合征,经类固醇激素治疗后头痛症状缓解,20 d后视力基本恢复。检索文献共收集了9例以视力障碍为表现、5例以头痛为表现的抗GQ1b抗体综合征患者资料,该类患者起病前均有前驱感染史,血清或脑脊液抗神经节苷脂抗体检测有助于早期诊断,早期予类固醇激素或Ig治疗后患者预后良好。结论抗GQ1b抗体综合征患者可以仅表现为孤立性的非典型症状,如头痛和视力障碍,当有前驱感染史时,应早期识别诊治。

Objective To analyze and summarize the clinical features of one patient with anti-GQ1b antibody syndrome presenting with rare and atypical manifestations of headache and visual disturbance.Methods Clinical data of a patient with anti-GQ1b antibody syndrome presenting with rare and atypical manifestations of headache and visual impairment were reported.Relevant case reports were retrieved from PubMed,Web of Science,CNKI and Wanfang Data using Chinese search terms of“visual disturbance”“visual impairment”“headache”and“head pain”,and English search terms of“GQ1b”“vision disorders”“visual disorders”“visual disturbance”“headache”“head pain”and“cephalalgia”,etc.Combined with literature review,the pathogenesis,clinical manifestations,laboratory and auxiliary examination and treatment prognosis of patients presenting with this type of manifestations were summarized.Results The 71-year-old male patient had a history of diarrhea at 3 weeks before the onset,manifested with headache and visual disturbance.Cerebrospinal fluid was detected for anti-GQ1b antibody(+)and anti-aquaporin 4(AQP-4)antibody(-).He was diagnosed with anti-GQ1b antibody syndrome.Headache symptoms were relieved by steroid treatment,and visual acuity was basically restored after 20 d.According to literature reviews,9 patients with anti-GQ1b antibody syndrome were manifested with visual impairment and 5 patients presented with headache.All these patients had a history of preinfection before the onset of disease.Serum or cerebrospinal fluid anti-ganglioside antibody detection contributed to early diagnosis.Prompt use of steroid hormone or immunoglobulin therapy yielded favorable prognosis.Conclusions Patients with anti-GQ1b antibody syndrome can only present with isolated atypical symptoms,such as headache and visual disturbance,if patients have pre-infection histories,early diagnosis and treatment should be performed.