脑出血合并多重抗神经元抗体阳性的副肿瘤性自身免疫性脑炎一例

A case report of paraneoplastic autoimmune encephalitis co-existence of with multiple anti-neuronal antibodies combined with cerebral hemorrhage

目的 探讨多重抗神经元抗体阳性的副肿瘤性自身免疫性脑炎(AE)的临床特点和诊治。方法 报道1例脑出血合并多重抗神经元抗体阳性的副肿瘤性AE的临床资料,分析、总结其临床特点。结果 老年男性患者,以脑出血起病,后伴随出现低钠血症为主要表现的抗利尿激素分泌不当综合征、精神症状和幻觉等,血清抗体检测显示抗γ-氨基丁酸B型受体(GABABR)抗体、抗神经元核抗体1型(抗Hu抗体)、抗Y染色体性别决定区相关高迁移率超家族1 (SOX1)抗体三重阳性,胸部CT平扫+增强显示肺癌合并多发转移,脑电图显示广泛性慢波,诊断为副肿瘤性自身免疫性脑炎。结论 多重抗体叠加出现可能导致临床特征的叠加或不典型,给早期诊断带来困难;多重抗体叠加出现高度提示肿瘤,且预后较差。组织免疫荧光法(TBA)和细胞免疫双荧光法(CBA)检测方法互补,有利于提高抗体检测的准确性。

Objective To investigate the clinical characteristics,diagnosis and treatment of paraneoplastic autoimmune encephalitis(AE)with multiple anti-neuronal antibodies.Methods A case of paraneoplastic autoimmune encephalitis co-existence with multiple anti-neuronal antibodies combined with with cerebral hemorrhage was reported.Results The elderly male patients initially suffered cerebral hemorrhage,then onset of hyponatraemia as the main manifestation of improper secretion of antidiuretic hormone syndrome,mental symptoms and hallucinations.Serum antibody test showed triple positive of anti-GABABR antibody,anti-Hu antibody and anti-SOX 1 antibody.Chest CT scan and enhancement showed lung cancer and metastasis.EEG showed wide slow wave.The diagnosis of paraneoplastic autoimmune encephalitis was made on the basis of the evidences above.Conclusion Co-existence with multiple anti-neuronal antibodies result in untypical clinical features,which causes diagnosis difficult.Multiple anti-neuronal antibodies highly suggests cancer and has a poor prognosis.TBA and CBA methods are complementary,which is conducive to improving the accuracy of antibody detection.