Ambiguous value of anti-ganglioside IgM autoantibodies in Guillain-Barre syndrome and its variants
Ambiguous value of anti-ganglioside IgM autoantibodies in Guillain-Barre syndrome and its variants
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DOI：
10.1007/s00415-015-7806-4
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发表时间：
2015-08-01
影响因子：
6
通讯作者：
Kanda, Takashi
中科院分区：
文献类型：
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作者：
Koga, Michiaki;Takahashi, Masaki;Kanda, Takashi
抗神经节苷脂自身抗体IgG型检测在一半的格林-巴利综合征（GBS）的患者，他们的检测强烈支持GBS的诊断。相反，抗神经节苷脂IgM抗体也经常在GBS患者中检测到，但IgM抗体是否指示GBS的诊断仍不清楚。我们在122例GBS及其变体患者中确定了4例GBS患者（3.3%），他们的IgM抗体检测呈阳性，但IgG抗体检测呈阴性。这4例患者均为青少年或年轻成人（年龄13-22岁），既往有胃肠道症状，近期有空肠弯曲菌肠炎的血清学和/或细菌学证据。血清IgG与C.从这些病人的粪便标本中分离出空肠。薄层层析免疫染色显示，他们的血清IgG反应与LOS的间苯二酚阳性部分，这表明这些患者有IgG自身抗体对唾液酸含表位，可能是未识别的神经节苷脂样结构的细菌LOS。我们还检测了22例C.空肠肠炎，随后没有神经系统疾病和检测IgM抗体7例（32%）。我们的数据表明，抗神经节苷脂IgM抗体可以检测到C。空肠肠炎无GBS并发症，抗神经节苷脂IgM抗体的检测并不总是支持GBS的诊断。针对未识别的神经节苷脂的IgG自身抗体可能在GBS患者的疾病发展中发挥作用，其中仅通过常规临床检测检测到抗神经节苷脂IgM抗体。
Anti-ganglioside autoantibodies of the IgG type are detected in a half of patients with Guillain-Barr, syndrome (GBS), and their detection strongly supports the diagnosis of GBS. In contrast, anti-ganglioside IgM antibodies are also often detected in GBS patients, but it remains unclear whether IgM antibodies indicate a diagnosis of GBS. We identified four GBS patients (3.3 %) who tested positive for IgM antibodies but negative for IgG antibodies among 122 patients with GBS and its variants. These four patients were all adolescents or young adults (age 13-22 years), experienced preceding gastrointestinal symptoms, and had serological and/or bacterial evidence of recent Campylobacter jejuni enteritis. Serum IgG reacted strongly with the lipo-oligosaccharide (LOS) of the C. jejuni isolates from these patients' stool specimens. Thin-layer chromatography with immunostaining showed that their serum IgG reacted with resorcinol-positive portion of LOS, suggesting that these patients had IgG autoantibodies against sialic acid-containing epitopes, probably unrecognized ganglioside-like structures on the bacterial LOS. We also examined anti-ganglioside autoantibodies in 22 patients with C. jejuni enteritis without subsequent neurological disorders and detected IgM antibodies in seven (32 %) patients. Our data indicate that anti-ganglioside IgM antibodies can be detected in C. jejuni enteritis without complication of GBS, and that the detection of anti-ganglioside IgM antibodies does not always support a diagnosis of GBS. IgG autoantibodies against unrecognized gangliosides might play a role in the development of disease in patients with GBS in whom only anti-ganglioside IgM antibodies are detected by routine clinical testing.