The clinical relevance of serum versus CSF NMDAR autoantibodies associated exclusively with psychiatric features: a systematic review and meta-analysis of individual patient data.
The clinical relevance of serum versus CSF NMDAR autoantibodies associated exclusively with psychiatric features: a systematic review and meta-analysis of individual patient data.
复制标题
DOI：
10.1007/s00415-022-11224-6
复制
发表时间：
2022-10
影响因子：
6
通讯作者：
David, Anthony
中科院分区：
文献类型：
--
作者：
Blackman, Graham;Lim, Mao Fong;Pollak, Thomas;Al-Diwani, Adam;Symmonds, Mkael;Mazumder, Asif;Carter, Ben;Irani, Sarosh;David, Anthony
多种精神综合征与NMDAR自身抗体相关;然而，当仅存在于血清中时，其临床相关性尚不清楚。我们探讨了是否可以区分CSF NMDAR自身抗体的患者与仅血清NMDAR自身抗体的患者。检索了电子数据库MEDLINE、EMBASE、PubMed和PsycINFO。纳入了报告具有孤立精神病特征和NMDAR自身抗体阳性的成人患者以及相关检查的文章。患者水平荟萃分析比较了CSF NMDAR自身抗体阳性患者与血清NMDAR自身抗体阳性但CSF NMDAR自身抗体阴性的患者。使用粗比值比（OR）分析二分数据，同时使用Mann-Whitney检验（U）分析连续数据。该方案已前瞻性注册（CRD 42018082210）。在4413篇出版物中，纳入了42篇，报告了79例患者。中位年龄为34岁（IQR 19岁）; 56%（45/79）为女性，24%（16/68）患有肿瘤。总共有41例患者CSF自身抗体阳性，20例仅血清自身抗体阳性。与仅血清自身抗体的患者相比，CSF自身抗体的患者更可能是女性（p < 0.001），并且症状发作更快（< 3个月）（p = 0.02）。他们也更可能出现精神病（p < 0.001），表现出EEG（p = 0.006），MRI（p = 0.002）和CSF（p = 0.001）异常，但不太可能出现失眠（p = 0.04）。根据临床人口统计学和调查结果，具有CSF NMDAR自身抗体的孤立性精神综合征患者可能与仅具有血清NMDAR自身抗体的患者区分开来。在线版本包含补充材料，可通过10.1007/s 00415 -022-11224-6获得。
A variety of psychiatric syndromes are associated with NMDAR autoantibodies; however, their clinical relevance when only present in the serum is unclear. We explored whether patients with CSF NMDAR autoantibodies could be distinguished from patients with serum-only NMDAR autoantibodies. The electronic databases MEDLINE, EMBASE, PubMed, and PsycINFO were searched. Articles reporting adult patients with isolated psychiatric features and positive for NMDAR autoantibodies with relevant investigations were included. Patient level meta-analysis compared patients positive for CSF NMDAR autoantibodies with patients positive for serum NMDAR autoantibodies, but negative for CSF NMDAR autoantibodies. Dichotomous data were analysed using crude odds ratios (OR), whilst continuous data were analysed using Mann–Whitney Test (U). The protocol was prospectively registered (CRD42018082210). Of 4413 publications, 42 were included, reporting 79 patients. Median age was 34 years (IQR 19 years); 56% (45/79) were female and 24% (16/68) had a tumour. In total, 41 patients were positive for CSF autoantibodies and 20 were positive for serum-only autoantibodies. Patients with CSF autoantibodies were significantly more likely to be female (p < 0.001) and have a rapid (< 3 month) onset of symptoms (p = 0.02) than patients with serum-only autoantibodies. They were also more likely to present with psychosis (p < 0.001), exhibit EEG (p = 0.006), MRI (p = 0.002), and CSF (p = 0.001) abnormalities, but less likely to present with insomnia (p = 0.04). Patients with an isolated psychiatric syndrome with CSF NMDAR autoantibodies can potentially be distinguished from those with serum-only NMDAR autoantibodies based on clinicodemographic and investigation findings. The online version contains supplementary material available at 10.1007/s00415-022-11224-6.
登录
查看更多内容
影响因子：
7.3
作者：
Ehrenreich H
通讯作者：
Ehrenreich H
影响因子：
1.7
作者：
O'Sullivan, S. S.;Mullins, G. M.;McNamara, B.
通讯作者：
McNamara, B.
影响因子：
9.9
作者：
Guasp, Mar;Martin-Aguilar, Lorena;Dalmau, Josep
通讯作者：
Dalmau, Josep
影响因子：
14.5
作者：
Kreye, Jakob;Wenke, Nina K.;Pruss, Harald
通讯作者：
Pruss, Harald
影响因子：
14.5
作者：
Planaguma, Jesus;Leypoldt, Frank;Dalmau, Josep
通讯作者：
Dalmau, Josep