The Diagnostic Value Of Nonspecific Neuron Membrane Antibody Test To Autoimmune Encephalitis

Background:Autoimmune Encephalitis（AE）is a noninfectious and inflammatory disease that have abnormal immune response to central nervous system^[1],along with the development of immunology and deeply detection technology,many specific antibodies have be found,such as AQP4,NMDA,SOX1,AMPA,LGI-1,Caspr2,DPPX,as well as the recently attention antibodies IgLon5 and GFAP.Some scholars put forward a bold guess:Name a brain protein,and an autoantibody shall be found^[2].Autoimmune encephalitis has become one of the hotspots in the research field of neuroimmunology,it explained no clear evidence of etiology before,and poor antiviral effect of the"viral encephalitis""sporadic encephalitis"cases.And enlarging encephalitis this pattern to the psychiatric,epilepsy,movement disorders,sleep disorders,cognitive disorders and other fields.At present,the diagnosis of AE is mainly based on the detection of specific AE antibodies.It has guiding significance for the selection of treatment modalities,the prevention of complications,the judgment of prognosis and the discovery of potential tumors.But the negative antibody can not exclude the diagnosis.This study for the patients that autoimmune encephalitis specific antibody detection negative but clinical highly suspected AE,collect their cerebrospinal fluid specimens and detect nonspecific neuronal antibody.To explore the application value of detection the nonspecific antibody in clinical diagnosis,so as to provide clinical guidance.A retrospective analysis of the cases of"central nervous system infection"and the good effect of immunotherapy in the past two years in our hospital is reviewed.Objective:For the patients that clinical highly suspected AE and autoimmune encephalitis specific antibody detection negative,then detect nonspecific neuronal antibody.Methods:Collecting patients with clinical suspected diagnosis of AE in2015.01 to 2017.01 in ZhongDa hospital,but their CSF autoimmune neuro-specificantibodiesdetection（including NMDA,AMPA1,AMPA2,Caspr2,LGI-1,GABAB）results are negative,a total of 52 cases.Collect their general information,and detect nonspecific neuronal antibody to their CSF speciments,and by comparing the positive and negative group of patients with clinical manifestations,laboratory examination and imaging examination,summary of its clinical features.Rusults:Among the 52 patients,31 were male,21 were female,19 were positive for nonspecific neuron antibody detection and 33 were negative.Positive group and negative group had no statistical significance in the patients with fever,headache,electrolyte disorder,consciousness,abnormal EEG,CSF pressure,white blood cell number（p>0.05）.In the mental and behavioral abnormalities,cognitive decline,seizures,cerebrospinal fluid IgG and protein increased and MRI abnormal had statistically significant（p<0.05）.Conclusion:The detection of nonspecific neuron antibody can improve the positive rate of the diagnosis of AE.It provides a more accurate basis for immunotherapy.There were significant differences in mental and behavioral abnormality,cognitive function decline,seizure,MRI signal abnormality（Especially in temporal lobe and hippocampal T2/FLAIR signal abnormality）and cerebrospinal fluid IgG and protein increased in patients between positive and negative group in nonspecific neuron membrane antibodies.