CSF herpes virus and autoantibody profiles in the evaluation of encephalitis.
CSF herpes virus and autoantibody profiles in the evaluation of encephalitis.
复制标题
DOI：
10.1212/nxi.0000000000000245
复制
发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
McKeon A
中科院分区：
文献类型：
--
作者：
Linnoila JJ;Binnicker MJ;Majed M;Klein CJ;McKeon A
报告临床实验室服务中脑炎（疱疹或自身免疫性）患者中共存疱疹病毒（单纯疱疹病毒 1 [HSV-1] 或 HSV-2、水痘带状疱疹病毒、EB 病毒 [EBV]、巨细胞病毒或人类疱疹病毒 6 [HHV-6]）和自身抗体的频率。对三组的疱疹病毒和抗体进行了评估：第 1 组——6 个月内通过实时 PCR 检测脑脊液呈疱疹病毒阳性的患者；第 2 组——脑脊液自身免疫性脑炎相关抗体呈阳性超过 5 年的患者（例如 NMDA 受体 [NMDA-R] 抗体），以及相同数量的无自身免疫性/传染病的对照；第3组——1年以上偶发的自身免疫性副感染性脑炎病例。在第 1 组中，100 份疱疹 PCR 阳性脑脊液标本 (CSF) 中有 27 份检测到抗体，除了一名患者在 EBV 感染后检测到 NMDA-R 抗体外，所有患者均检测到未分类的神经或非神经抗体。在提交重复 PCR 检测的 7 个 CSF 中，有 3 个也检测到了抗体（未分类，2 个；AMPA 受体，1 个）。在第2组中，77名对照者中的1名（HHV-6）和77名自身免疫性脑炎患者中的4名（EBV，2；HHV-6，2）中检测到疱疹病毒；自身抗体针对 3/4 的 NMDA-R 和 1/4 的 GABAB-R。在第 3 组中，7 名 HSV-1 脑炎患者中检测到 NMDA-R 抗体。其余 3 名患者中，2 名检测到未分类的神经抗体，1 名患有 GABAB-R 自身免疫。第 2 组和第 3 组各有 2 名患者发现了伴随肿瘤。自身抗体和疱疹病毒 DNA 经常在脑炎 CSF 中共存。一些患者在中枢神经系统病毒感染后出现副感染性自身免疫（通常是 HSV-1 脑炎）。检测其他人的疱疹核酸的意义仍不清楚。
To report the frequency of coexisting herpes viruses (herpes simplex virus 1 [HSV-1] or HSV-2, varicella zoster virus, Epstein-Barr virus [EBV], cytomegalovirus, or human herpes virus 6 [HHV-6]) and autoantibodies in patients with encephalitis (herpes or autoimmune) in clinical laboratory service. Three groups were evaluated for herpes viruses and antibodies: group 1—patients whose CSF was positive for a herpes virus by real-time PCR over a period of 6 months; group 2—patients whose CSF was positive for an autoimmune encephalitis–associated antibody over 5 years (e.g., NMDA receptor [NMDA-R] antibody), and the same number of controls without autoimmune/infectious disease; and group 3—incidental autoimmune parainfectious encephalitis cases encountered over 1 year. In group 1, antibodies were detected in 27 of 100 herpes PCR-positive CSF specimens (CSFs), either unclassified neural or nonneural in all but one patient with NMDA-R antibody detected after EBV infection. Antibodies were also detected in 3 of 7 CSFs submitted for repeat PCR testing (unclassified, 2; AMPA receptor, 1). In group 2, herpes viruses were detected in 1 of 77 controls (HHV-6) and 4 of 77 patients with autoimmune encephalitis (EBV, 2; HHV-6, 2); autoantibodies targeted NMDA-R in 3/4 and GABAB-R in 1/4. In group 3, NMDA-R antibody was detected in 7 patients post–HSV-1 encephalitis. Of the remaining 3 patients, 2 had unclassified neural antibodies detected, and one had GABAB-R autoimmunity. Concomitant neoplasms were discovered in 2 patients each from groups 2 and 3. Autoantibodies and herpes virus DNA frequently coexist in encephalitic CSF. Some patients develop parainfectious autoimmunity following viral CNS infection (usually HSV-1 encephalitis). The significance of detecting herpes nucleic acids in others remains unclear.