儿科MOG-Ab相关脑炎:支持早期识别和治疗
Nee Na Kim1, Dimitrios Champsas1, Michael Eyre1
1From the Department of Neurology (N.N.K., O.A.-M., Y.H.), Great Ormond Street Hospital for Children NHS Foundation Trust; Department of Neuroinflammation (N.N.K., D.C., O.A.-M., C.H., O.C., Y.H.), Institute of Neurology, University College London; Children's Neurosciences (M.E., V.L., M.L., T.R.), Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust; Department of Women and Children's Health (M.E., M.L., T.R.), School of Life Course Sciences (SoLCS), King's College London; Department of Paediatrics (A.S., S.R., J.P.), Children's Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust; Department of Paediatric Neurology (M.V.C.), Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust; Translational and Clinical Research Sir James Spence Institute (R.F.), University of Newcastle, Royal Victoria Infirmary; Department of Neurology (R.F.), Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust; Department of Neurology (R.K.), Alder Hey Children's Hospital, Alder Hey Children's NHS Foundation Trust, Liverpool; Department of Paediatric Neurology (D.R., Siobhan West), Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust; Department of Neurology (E.W., Sukhvir Wright), Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust; Department of Neuroradiology (A.B., K.M.), Great Ormond Street Hospital, Great Ormond Street Hospital Trust, London, United Kingdom; Department of Neurology (E.P.F.), Laboratory Medicine and Pathology and Center for Multiple Sclerosis and Autoimmune Neurology, Rochester, MN; NIHR University College London Hospitals Biomedical Research Centre (O.C.); and Department of Neuroinflammation (O.C.), National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, United Kingdom.
在儿童中,髓寡腺细胞糖蛋白抗体 (MOG-Ab) 脑炎的表现与急性传播性脑炎 (ADEM) 不同. 早期免疫抑制对于MOG-Ab阳性病例至关重要,即使是正常的MRI.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 儿科 儿科 儿科
背景情况:
- 髓寡细胞糖蛋白抗体 (MOG-Ab) 在急性扩散性脑炎 (ADEM) 之外,也与脑炎有关.
- 了解儿童的MOG-Ab脑炎对于准确的诊断和管理至关重要.
研究的目的:
- 评估一组患有MOG-Ab脑炎但不符合ADEM标准的儿童队列.
- 为了将他们的临床和准临床特征与被诊断为ADEM的儿童进行比较.
主要方法:
- 对患有MOG-Ab.的儿科患者 (<18岁) 进行了回顾性多中心队列研究.
- 分为脑炎表型 (非ADEM) 和ADEM组的分层.
- 使用曼·惠特尼U测试和千平方/费舍尔精确测试进行统计比较.
主要成果:
- 33名儿童患有MOG-Ab脑炎,74名患有ADEM.
- 脑炎的症状包括头痛 (88%),发作 (73%) 和发烧 (67%).
- 与ADEM患者相比,患有脑炎的儿童年龄较大,更有可能需要重症监护,晚些时候接受类固醇治疗,并且在随访时的发病率较高.
结论:
- 建议对所有疑似脑炎病例进行MOG-Ab测试,包括那些脑部MRI正常的人.
- 免疫能力较强的儿童的负性感染标志物不应延迟疑似免疫媒介疾病的免疫抑制治疗.
- 在等待MOG-Ab结果时,早期启动免疫抑制 (类固醇,IVIG,血交换) 是至关重要的.
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