抗谷氨酸脱羧酶65抗体脑炎及相关自身免疫性多内分泌腺病综合征

Anti-glutamic acid decarboxylase 65 antibody-associated autoimmune encephalitis and associated autoimmune polyendocrinopathy syndrome

抗谷氨酸脱羧酶65(GAD65)抗体脑炎是自身免疫性脑炎的一种亚型,常表现为僵人综合征、小脑性共济失调、颞叶癫痫等神经综合征,早期识别诊断并给予免疫治疗对于患者的预后有极大改善。目前对于抗GAD65抗体脑炎的诊断主要依赖于血清中检测出高滴度的GAD65抗体或脑脊液中GAD65抗体阳性,然而GAD65抗体与广泛的自身免疫性疾病相关,在非神经系统中可引起自身免疫疾病包括1型糖尿病和甲状腺炎等。因此,诊治抗GAD65抗体脑炎的过程中需要筛查潜在的内分泌腺体的变化,在多内分泌免疫环境下出现神经症状也需要考虑合并抗GAD65抗体脑炎的可能。

Anti-glutamic acid decarboxylase 65(GAD65)antibody-associated autoimmune encephalitis is a subtype of autoimmune encephalitis.It is often manifested as neurological syndromes such as stiff-person syndrome,cerebellar ataxia and temporal lobe epilepsy.Early diagnosis and immunotherapy can greatly improve the prognosis of patients with this disease.The current diagnosis of anti-GAD65 antibody-associated autoimmune encephalitis mainly relies on the detection of high titers of GAD65 antibodies in serum or positive GAD65 antibody in cerebrospinal fluid.However,GAD65 antibodies have been associated with a wide range of autoimmune diseases,including non-neurological autoimmune diseases type 1 diabetes and thyroiditis.Therefore,it is necessary to screen for changes in other endocrine glands during the diagnosis and treatment of anti-GAD65 antibody-associated autoimmune encephalitis,and the possibility of concomitant anti-GAD65 antibody-associated autoimmune encephalitis should also be considered for neurological symptoms that occur in a polyendocrine immune environment.