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首页> 外文期刊>Journal of neurology >Routine diagnostics for neural antibodies, clinical correlates, treatment and functional outcome
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Routine diagnostics for neural antibodies, clinical correlates, treatment and functional outcome

机译：神经抗体的常规诊断，临床关联，治疗和功能结果

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Objective To determine frequencies, interlaboratory reproducibility, clinical ratings, and prognostic implications of neural antibodies in a routine laboratory setting in patients with suspected neuropsychiatric autoimmune conditions. Methods Earliest available samples from 10,919 patients were tested for a broad panel of neural antibodies. Sera that reacted with leucine-rich glioma-inactivated protein 1 (LGI1), contactin-associated protein-2 (CASPR2), or the voltage-gated potassium channel (VGKC) complex were retested for LGI1 and CASPR2 antibodies by another laboratory. Physicians in charge of patients with positive antibody results retrospectively reported on clinical, treatment, and outcome parameters. Results Positive results were obtained for 576 patients (5.3%). Median disease duration was 6 months (interquartile range 0.6-46 months). In most patients, antibodies were detected both in CSF and serum. However, in 16 (28%) patients with N-methyl-d-aspartate receptor (NMDAR) antibodies, this diagnosis could be made only in cerebrospinal fluid (CSF). The two laboratories agreed largely on LGI1 and CASPR2 antibody diagnoses (kappa = 0.95). The clinicians (413 responses, 71.7%) rated two-thirds of the antibody-positive patients as autoimmune. Antibodies against the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), NMDAR (CSF or high serum titer), gamma-aminobutyric acid-B receptor (GABABR), and LGI1 had >= 90% positive ratings, whereas antibodies against the glycine receptor, VGKC complex, or otherwise unspecified neuropil had = 3 months, mostly with >= 1 immunotherapy intervention. Conclusions This novel approach starting from routine diagnostics in a dedicated laboratory provides reliable and useful results with therapeutic implications. Counseling should consider clinical presentation, demographic features, and antibody titers of the individual patient.
机译：目的确定神经抗体在疑似神经精神自身免疫病症患者常规实验室环境中神经抗体对神经抗体的频率，互上的再现性，临床评估和预后意义。方法对10,919名患者的最早可用样品用于宽面板的神经抗体。用另一个实验室对Lgi1和Caspr2抗体重新测试与富含亮氨酸的胶质瘤 - 灭活蛋白1（LgI1），接触相关蛋白-2（CasPr2）或电压门控钾通道（VGKC）复合物进行反应的血清。负责患者患有阳性抗体患者的医生在临床，治疗和结果参数上回顾性。结果576名患者获得阳性结果（5.3％）。中位疾病持续时间为6个月（四分位数0.6-46个月）。在大多数患者中，在CSF和血清中检测到抗体。然而，在16名（28％）N-甲基-D-天冬氨酸受体（NMDAR）抗体患者中，该诊断只能在脑脊液（CSF）中进行。两位实验室很大程度上同意Lgi1和Caspr2抗体诊断（Kappa = 0.95）。临床医生（413反应，71.7％）额定三分之二的抗体阳性患者自身免疫。抗α-氨基-3-羟基-5-甲基-4-异恶唑丙酸受体（AMPAR），NMDAR（CSF或高血清滴度），γ-氨基丁酸-B受体（GABABR）和LGI1的抗体> = 90 ％阳性额定值，而对甘氨酸受体的抗体，VGKC复合物或其他未指明的神经尿= 3个月，主要是具有> = 1个免疫疗法干预。结论从专用实验室中的常规诊断开始的这种新方法提供了具有治疗意义的可靠和有用的结果。咨询应考虑个体患者的临床介绍，人口统计学特征和抗体滴度。

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