GABAB receptor autoantibody frequency in service serologic evaluation
GABAB receptor autoantibody frequency in service serologic evaluation
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DOI：
10.1212/wnl.0b013e3182a35271
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发表时间：
2013-09-03
期刊：
影响因子：
9.9
通讯作者：
McKeon, Andrew
中科院分区：
文献类型：
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作者：
Jeffery, Oliver J.;Lennon, Vanda A.;McKeon, Andrew
目的：小细胞肺癌（SCLC）和边缘脑炎是公认的g-氨基丁酸-B受体（GABA(B)R）自身抗体伴生。我们试图在诊断血清学实验室中确定GABA(B) r -免疫球蛋白G （IgG）的频率和伴随（神经学、肿瘤学和血清学）。方法：用间接免疫荧光法检测3组患者血清和脑脊液中GABA(B)R-IgG的含量，并转染HEK293细胞。第1组包括3,989例在疑似自身免疫性脑病服务评估中检测GABA(B)R-IgG的患者。第2组包括49例未分类的CNS突触IgG检测（先于GABA(B)R自身抗体描述）。第三组包括384例患者，检测到>= 1的sclc预测自身抗体。结果：17例患者（血清14例，脑脊液11例）检测到GABA(B) r特异性IgG。1、2组血清阳性患者均有n型钙通道抗体与GABA(B)R-IgG共存。第1组3989例患者中有7例阳性（0.2%）。所有人都患有边缘脑炎；5人患有SCLC。4例患者接受免疫治疗，神经功能得到改善。2组49例患者中5例阳性（10%）。3例边缘脑炎，1例快速进行性脑脊髓病，1例小脑性共济失调。2例为小细胞肺癌，1例为多发性骨髓瘤。第3组384例患者中，5例阳性（1.3%）；滴度低（仅通过转染细胞试验检测）。神经系统表现多样，可归因于共存的t细胞介导的自身免疫（由CRMP-5 IgG [2]， ANNA-1[2]和ANNA-3[2]表示），而不是GABA(B)R-IgG。结论：GABA(B)R自身抗体是一种罕见但可治疗的副肿瘤神经系统疾病的标志物，通常发生在边缘脑炎和SCLC。
Objective: Small-cell lung carcinoma (SCLC) and limbic encephalitis are recognized g-aminobutyric acid-B receptor (GABA(B)R) autoantibody accompaniments. We sought to determine in a diagnostic serology laboratory the frequency and accompaniments (neurologic, oncologic, and serologic) of GABA(B)R-immunoglobulin G (IgG).Methods: We tested stored serum and CSF specimens from 3 patient groups for GABA(B)R-IgG by indirect immunofluorescence on mouse brain tissue and transfected HEK293 cells. Group 1 included 3,989 patients tested for GABA(B)R-IgG in service evaluation for suspected autoimmune encephalopathy. Group 2 included 49 patients with an unclassified CNS synaptic IgG detected (antedating descriptions of GABA(B)R autoantibody). Group 3 included 384 patients in whom >= 1 SCLC-predictive autoantibodies had been detected.Results: GABA(B)R-specific IgG was detected in 17 patients (serum, 14; CSF, 11). N-type calcium channel antibody coexisted with GABA(B)R-IgG in all seropositive patients of groups 1 and 2. In group 1, 7 of 3,989 patients were positive (0.2%). All had limbic encephalitis; 5 had SCLC. Four patients received immunotherapy and improved neurologically. In group 2, 5 of 49 patients were positive (10%). Three had limbic encephalitis, 1 had rapidly progressive encephalomyelopathy, and 1 had cerebellar ataxia. Two patients had SCLC and 1 had multiple myeloma. In group 3, 5 of 384 patients were positive (1.3%); titers were low (detected only by transfected cell assay). The neurologic presentations were diverse and attributable to coexisting T-cell-mediated autoimmunity (indicated by CRMP-5 IgG [2], ANNA-1 [2], and ANNA-3 [2]), rather than to GABA(B)R-IgG.Conclusion: GABA(B)R autoantibody is a marker of an uncommon but treatable paraneoplastic neurologic disorder, usually occurring in the setting of limbic encephalitis and SCLC.