脑囊虫病各病期囊虫抗体变化及意义

用ＥＬＩＳＡ方法检测３６例经头颅ＣＴ或ＭＲＩ检查诊断的脑囊虫病患者血及脑脊液中囊虫抗体，发现在脑囊虫各不同病期，囊虫抗体阳性率存在极显著差异（Ｐ＜０．００５），以活动期及有存活囊尾蚴为主的混合期抗体阳性率高。在一定程度上对临床选择正确治疗方案提供帮助。     

单纯疱疹病毒脑炎的非典型临床表现

目的对临床表现和实验室检查结果不具典型特征的单纯疱疹病毒脑炎患者进行回顾性总结，以提高对本病的诊断水平。方法对142例单纯疱疹病毒脑炎患者的病史、临床表现、脑脊液细胞学检查、脑脊液及血清病毒学、脑电图及神经影像学资料进行分析。结果142例中38例(26．76％)为非急性起病，受损部位除常见的额、颞叶外，还可侵及脑干。50例(35．21％)脑脊液细胞学检查以中性粒细胞升高为主，而非淋巴细胞占优势。69例行脑脊液特异性1型单纯疱疹病毒IgM抗体检测，阳性者12例(17．39％)，余57例(82．61％)均呈阴性。17例行双份血清和脑脊液标本特异性IgG抗体检测，其中恢复期标本1型单纯疱疹病毒IgG抗体水平增高4倍以上者5例，无明显变化者9例，恢复期抗体水平降低4倍者3例。68例中65例(95．59％)脑电图未见典型的局灶性尖、棘波。52例患者接受影像学检查(MRI检查10例，CT检查42例)，其中28例未见典型影像学改变，分别占受检者的30．00％(3／10)和59．52％(25／42)。结论单纯疱疹病毒脑炎的起病、临床表现和实验室检查可呈不典型表现，明确诊断有赖于对各项资料进行综合分析。对于亚急性或慢性起病患者，建议检测双份血清和脑脊液标本中的特异性1型单纯疱疹病毒IgG抗体，以对病毒抗体水平进行连续和动态观察。     

抗N-甲基-D-天冬氨酸受体脑炎患者临床特点分析

目的 探讨抗N-甲基-D-天冬氨酸受体(N-methyl- D-aspartate receptor,NMDAR)脑炎的临床特征与抗NMDAR抗体在诊断该病中的意义.方法 选择62例各种病因的脑炎、脑病及其他中枢神经系统疾病患者,采用转染细胞间接免疫荧光法检测其血清及脑脊液抗NMDAR抗体,同时对该病的临床表现、实验室检查、治疗及预后进行分析.结果 28％(9/32)的临床诊断脑炎病例组患者血清或脑脊液抗NMDAR抗体为阳性.脑脊液抗体的阳性率高于血清,其中5例抗体滴度较高的患者伴有血脑屏障破坏.这些患者均未发现肿瘤,临床上以发热、精神异常、癫痫、肌张力障碍与自主神经功能障碍表现突出,并有头颅MRI与脑电图异常,早期免疫治疗有效.结论 脑脊液及血清中抗NMDAR抗体检测有助于自身免疫性抗NMDAR脑炎患者的早期诊断与治疗.     

多发性硬化与髓鞘抗体及髓鞘碱性蛋白

探讨多发性硬化的免疫发病机制。方法采用ELISA方法测定多发性硬化患者活动期血清（28例）和脑脊液（18例）的GM1抗体、脑磷脂抗体和髓鞘碱性蛋白。结果多发性硬化患者血清GM1抗体阳性率为36％,脑磷脂抗体为43％;脑脊液GM1抗体为11％,脑磷脂抗体为18％,与对照组比较差异均有显著性;血清和脑脊液的髓鞘碱性蛋白增高亦有意义。结论体液免疫参与了多发性硬化的发病过程。可能的机制是,针对自身组织的髓鞘蛋白、髓鞘脂质等自身免疫系统被激活,产生一系列病理改变和临床症状。     

结核性脑膜炎免疫乳胶试剂的研制及临床观察

本文采用自制免疫乳胶试剂对４５例结核性脑膜炎及３２例非结核性脑膜炎患者脑脊液进行了结核菌抗体检测，４５例结核性脑膜炎抗体检测４４例阳性，检测阳性率９７．８％，３２例非结核性脑膜炎抗体检测均为阴性，特异性１００％，首次提出了一项快速，敏感，特异，简便，易于推广的新诊断技术。     

多发性硬化患者血清及脑脊液的神经节苷酯抗体检测

目的 观察多发性硬化（MS）患者血清及脑脊液（CSF）中神经节苷抗体的分布，研究其在MS发病过程中的作用。方法 采用改良Marcus法检测20例MS患者血清和CSF神经节苷酯抗体的水平。结果 20例MS患者CSF和血清神经节苷酯抗体阳性率分别为75％，65％；和对照组比较均有显著性差异（P＜0．01）。结论 神经节苷酯抗体与参与了MS的发病过程。     

磁共振成像及脑脊液细胞学对病毒性脑（膜）炎的诊断性研究

目的探讨MRI和脑脊液细胞学检测阳性率、异常程度和发病时间对病毒性脑（膜）炎诊断和制定治疗方案的指导价值。方法回顾189例病毒性脑（膜）炎患者的头部MRI及脑脊液检查资料,分析MRI正常或异常患者在疾病早期的脑脊液细胞学改变。结果189例患者中96例（50．79％）呈现MRI异常影像、129例（68．25％）脑脊液细胞学检测异常。MRI异常患者中脑脊液细胞学检测异常率为72．92％（70／96）,与MRI正常患者（63．44％,59／93）比较差异具有统计学意义（P=0．000）。结论病毒性脑（膜）炎患者在疾病早期MRI改变晚于脑脊液细胞学改变,但二者对提示诊断和制定治疗方案均具有重要临床意义。     

多发性硬化活动期病人脑脊液T淋巴细胞亚群的异常

作者等应用荧光素标记的单克隆抗体和激光流式细胞光度计方法检测了活动期多发性硬化(MS)(7例)、非活动期MS(7例)、CNS炎症(5例)和和CNS非炎症疾病(12例)病人周围血和脑脊液T淋巴细胞亚群的变化情况,并报道如下:按Rose诊断标准确诊的14例病人,可分为活动期和非活动期两组.活动组均为出现新症状或原症     

多发性硬化患者抗髓鞘少突胶质细胞糖蛋白抗体的检测及其意义

目的　检测多发性硬化 (MS)患者抗髓鞘少突胶质细胞糖蛋白抗体并探讨其意义。方法　采用EL ISA方法测定 5 6例多发性硬化患者急性期血清和脑脊液配对标本的抗髓鞘少突胶质细胞糖蛋白 (MOG)抗体 ,30例其它神经疾病 (OND)患者为对照。结果　 MS患者血清和脑脊液均可测到抗 MOG抗体 ,血清抗 MOG抗体阳性率为 35 .7% ,脑脊液抗 MOG抗体阳性率为 4 2 .8% ,OND组血清和脑脊液抗 MOG抗体阳性率均为 6 .7% ,与 OND组比较均有显著性意义 (P<0 .0 5 ) ,但血清和脑脊液比较无显著性意义 (P>0 .0 5 )。结论　多发性硬化患者血清和脑脊液中均可检测到抗 MOG抗体 ,可为临床诊断和治疗提供指导。     

运用PCR及ABC—ELISA法早期诊断结论性脑膜炎的评价

收集了４１例结核性脑膜炎（结脑）患者和３０例非结脑患者脑脊液，运用ＰＣＲ法扩增结核蛋白抗原Ｂ上ＤＮＡ序列４１９ｂｐ片段，用ＡＢＣ－ＥＬＩＳＡ检测抗结核蛋白抗体。结脑组ＰＣＲ阳性率７５．７％（３１／４１），抗结核抗体阳性率６３．５％（２６／４１）；对照组ＰＣＲ全部阳性，抗结核抗阳性率１３．３％。ＰＣＲ阳性可在发病第２天查到且在治疗６个月时仍可见ＰＣＲ阳性。随病程延长抗全阳性率上升。运用ＰＣＲ及ＡＢＣ     

Multiple specificities of antibrain antibodies in multiple sclerosis and chronic myelopathy

The presence of complement-fixing antibodies against brain antigens was tested in paired serum and cerebrospinal fluid (CSF) samples from 60 multiple sclerosis (MS) patients, 15 patients with chronic myelopathy of undetermined cause (CM) and 60 control patients. Six MS sera, 34 MS CSF, 4 CM sera, 3 CM CSF, 4 control sera and 1 control CSF gave positive reactions either with a lipid extract or a saline extract of normal human brain. The proportion of anticomplementary CSF was significantly higher in the MS group than in the control group (15% vs 0%, P < 0.01). The reactivity of a large number of individual positive samples was further investigated. Seven antibody specificities were discerned in the MS samples. Most samples reacted with nonlipid antigens, the dominating being a heat-labile, nonlipid component associated with CNS myelin. Antibodies to cerebroside and sulfatide were detected in a few patients. A number of samples reacted with cholesterol in combination with a variety of lipids. Positive samples from the CM patients exhibited a similar heterogeneity. In the control group positive reactions were seen in one patient with systemic lupus erythematosus (SLE), two patients with rheumatoid arthritis (RA), and one with a spinal meningioma. The reaction patterns of these patients were different from those commonly seen in MS patients. The complement-fixing antibrain antibodies in MS CSF are usually of IgG class (Ryberg 1976). This applies also to the positive MS sera in this study. The distribution of the antibodies between serum and CSF indicated, in several cases, an intrathecal synthesis. All of a number of human brains, including one MS brain, contained all 6 antigens (haptens) reactive in saline extracts. Antibodies to tissues outside the CNS were rarely detected in MS patients. The varied humoral autoimmune response in MS might reflect a heterogeneity in the MS patients, the disease itself or its causative agent.     

Chlamydia pneumoniae infection associated with enhanced MRI spinal lesions in multiple sclerosis

Cerebrospinal fluid (CSF) from 66 patients with multiple sclerosis (MS) and 25 patients with other neurological diseases (OND) were examined for the infection of Chlamydia pneumoniae by culture, polymerase chain reaction (PCR) assay, and determination of antibodies to C. pneumoniae. PCR was positive not only in 9 of 28 (32%) patients with MS but also in 2 patents with inflammatory disorders in 15 (13%) OND controls (p = 0.18). Viable C. pneumoniae was isolated from one patient with MS and one with paraneoplastic encephalomyelitis. C. pneumoniae could be detected only in cell-containing CSF. In MS, enhanced spinal magnetic resonance imaging (MRI) lesions were detected in all of four PCR-positive patents but none of five PCR-negative patients, and the difference was significant (p = 0.0079). However, no correlation was found between enhanced brain MRI lesions and CSF C. pneumoniae DNA. Elevated titers of anti-C. pneumoniae IgG were detected in CSF in 13 of 66 (20%) patients with MS and 1 of 25 (4%) OND controls (p = 0.064). CNS C. pneumoniae infection is not uncommon in MS as well as in other inflammatory disorders of the nervous system. The association of active spinal lesions with Chlamydia in CSF collected by lumber puncture suggests the detection of a recent infection. On the other hand, the lack of association of active MS brain lesions with CSF Chlamydia and the presence of PCR-positive patents who are clinically stable and have no enhancing MRI lesions imply the existence of a chronic infectious process.     

Cerebrospinal fluid molecular demonstration of Chlamydia pneumoniae DNA is associated to clinical and brain magnetic resonance imaging activity in a subset of patients with relapsing-remitting multiple sclerosis

To further explore the link between Chlamydia pneumoniae and multiple sclerosis (MS), we examined cerebrospinal fluid (CSF) samples from 71 patients with MS and from 72 patients suffering from other inflammatory neurological disorders (OIND) or noninflammatory neurological disorders (NIND). All samples were analysed by a touchdown nested polymerase chain reaction (n-PCR) for C. pneumoniae with primer sets which amplify target sequence genes encoding the major outer membrane protein (MOMP), the 16S rRNA and the Hsp-70 protein. A molecular study was also performed to evaluate genetic diversity among isolates of C. pneumoniae and to compare chlamydial sequences. PCR was found positive in 36.6% of total MS, in 28.1% of OIND and in 37.5% of NIND patients, without any statistical differences among the various groups examined. CSF PCR evidence of C. pneumoniae was significantly more frequent in relapsing-remitting (RR) than in secondary progressive (SP) (P < 0.001) and in primary progressive (PP)MS (P < 0.05), in clinically active than in clinically stable MS (P < 0.05) and in MRI active than in MRI inactive MS (P < 0.001). The analysis of CSF expression of each single C. pneumoniae-specific gene revealed that detectable levels of MOMP were significantly more frequent in MS patients with relapse (P < 0.05), whereas PCR positivity for MOMP and 16S rRNA genes were more represented in MS patients with clinical and MRI evidence of disease activity (P < 0.05). Similar rates for MOMP and 16S rRNA genes were detected in CSF of both MS patients and controls, whereas CSF PCR positivity for Hsp-70 gene was observed in only three active RR MS patients. Sequence analysis revealed significant homologies with C. pneumoniae compared to other Chlamydial spp. These findings confirm that the C. pneumoniae detection within the central nervous system (CNS) is not selectively restricted to MS, but accounts in a variety of neurological diseases. In addition, our results suggest that CSF C. pneumoniae-specific DNA detection can occur in a subset of MS patients with clinical and MRI active RR form in whom a C. pneumoniae brain chronic persistent infection may play a significant role in the development of disease.     

多发性硬化患者血清和脑脊液Epstein-Barr病毒抗体检测的意义

目的探讨多发性硬化(MS)患者血清和脑脊液(CSF)中EpsteinBarr(EB)病毒IgG抗体检测的意义。方法采用酶联免疫吸附法检测MS患者65例、其他神经科疾病(OND组)患者71例、非神经科疾病(NND组)患者42例的血清和CSF中EB病毒核抗原、壳抗原和早期抗原的IgG抗体,并进行分析比较。根据血清抗体检测结果的组合,分析各组中病毒初次感染、既往感染和病毒重新激活的情况。结果3组患者血清EB病毒核抗原、壳抗原IgG抗体阳性率均>90%,差异无显著性(均P>0.05)。MS组EB病毒早期抗原IgG抗体阳性率(46.2%)明显高于其他两组(18.3%,9.5%,均P<0.05)。MS组病毒感染重新激活的比率(46.2%)明显高于其他两组(18.3%,9.5%,均P<0.05)。3组CSF病毒抗体阳性率差异无显著性(均P>0.05)。结论MS患者活动性的EB病毒感染较多,EB病毒感染重新激活的比例很高。     

隐球菌性脑膜炎患者抗原及抗体检测的临床评价

目的:评价隐脑患者血液、脑脊液中抗原抗体检测的临床意义。方法:应用乳胶凝集试验和试管凝集法检测28例隐脑患者脑脊液和血液中的抗体和抗原并对部分患者的抗原抗体进行动态监测。结果:应用乳胶凝集试验检测,28例隐脑患者脑脊液和血液中的抗原全部阳性,15位患者血液中抗体12例阳性,3例阴性。结论:应用乳胶凝集法检测脑脊液和血液中的抗原对隐脑的早期诊断有重要临床诊断意义。动态监测抗原可对隐脑的治疗效果进行评价     

Antibrain antibodies in multiple sclerosis: Relation to clinical variables

IgG antibrain antibodies (ABA) of several specificities can be demonstrated in multiple sclerosis (MS) with the complement fixation technique. This technique seems to discriminate between IgG specifically and non-specifically bound to CNS preparations. Complement-fixing ABA were titrated in paired serum and CSF samples from 87 patients with clinically definite MS, 15 patients with probable MS, 29 patients with other neurological diseases, and 13 “healthy” controls. In addition, sera from 55 non-MS patients were tested. In 40% of the sera and 88% of the CSF samples from patients with clinically definite MS, ABA reacting with human brain homogenate were demonstrated. The corresponding figures for probable MS were 21% and 73%, and for the controls 11% and 6%. Two of 9 sera from patients with the Guillain-Barré syndrome were strongly positive. There was a tendency for higher CSF ABA titres in younger MS patients and in those with an earlier onset of disease. ABA titres in serum and CSF were both correlated with a more malignant course. Irrespective of the mechanism of induction of ABA in MS - an excessive immunogenic stimulation and/or a defective immunoregulation - they are potentially pathogenic in several ways, e.g. (1) by direct antibody action, (2) by interaction with complement, (3) by antibody-dependent K-cell-mediated cytotoxicity, and (4) by interaction with phagocytic cells.Of several correlations among the routine CSF variables in MS, the finding of more pronounced abnormalities in male patients was notable.     

Antibodies to brain tissue in sera of patients with chronic progressive multiple sclerosis

Using a blind indirect immunofluorescence assay we examined the sera of 30 multiple sclerosis (MS) patients and 30 age- and sex-matched controls for autoantibodies to brain tissue. Binding was found in 33% of the patients' sera and in only 3% of the controls' sera. Positive and negative patients differed significantly in the course of MS, since eight of the ten positive patients showed a chronic progressive form. None of the patients with a large deficit in a chronic state showed antibodies to brain tissue, while eight of the 11 active chronic progressive cases were positive. Therefore it seems possible that these brain antibodies could be used as an activity parameter, at least for this form of the disease.     

Children suspected of having intracranial infection with normal brain magnetic resonance imaging may be associated with the myelin oligodendrocyte glycoprotein antibody

PurposeTo confirm whether encephalitis due to unknown causes but with normal brain magnetic resonance imaging (MRI) may be associated with the myelin oligodendrocyte glycoprotein (MOG) antibody.MethodsWe retrospectively analyzed and summarized the characteristics of three patients initially suspected of having intracranial infections with normal brain MRI, and ultimately tested positive for anti-MOG antibody.ResultsThe three patients mainly presented with long-term fever accompanied by headaches and drowsiness. Auxiliary examinations showed obvious leukocytosis in peripheral blood and leukocytosis and increased protein expression in cerebrospinal fluid (CSF); furthermore, brain MRI was normal. These findings suggested intracranial infection, especially bacterial meningitis. No patient showed a response to prolonged anti-bacterial therapy; however, they recovered with glucocorticoid therapy, which was prescribed after anti-MOG antibodies were detected in the serum and CSF samples.ConclusionAnti-MOG antibody detection should be performed early for patients with suspected encephalitis due to unknown causes with normal brain MRI, to identify whether they have MOG antibody-associated diseases (MOGAD).     

Comparative study of immunoenzyme tests ELISA-G and ELISA-M, indirect immunofluorescence, and complement fixation in the diagnosis of human cysticercosis]

A comparative study of four immunological tests used for anti-Cysticercus antibodies detection--Enzyme-Linked ImmunoSorbent Assay IgG (ELISA-G) and IgM (ELISA-M), indirect immunofluorescence (RIFI) and complement fixation (RFC)--was made in serum and cerebrospinal fluid (CSF). 539 patients with symptoms suggesting cysticercosis, 450 relatives of these patients and 133 normal people (control group) were examined. 1122 serum samples and 120 CSF samples were analysed by ELISA-G and RIFI, 83 sera and 60 CSF also by RFC, and 28 CSF by ELISA-M. 5.2% serum samples were reagent in ELISA-G and RIFI, and 3.5% of them had discordant results. All control group sera were negative. The same tests in CSF were positive in 16.7% and had discordant results in 7.5%. ELISA-G and RIFI in serum and CSF had concordant results in 89.6% (17.7% were positive). ELISA-G, RIFI and RFC had concordant results in 54.2% sera (16.9% positives) and in 81.7% CSF (11.7% positives). When ELISA-G and RIFI were negative, RFC was positive in 41.0% sera and 11.7% CSF. ELISA-G and ELISA-M had concordant results in 78.6% CSF. When these results were discordant ELISA-G was positive in 10.7% and ELISA-M in another 10.7%. It is necessary to use concomitantly several immunological tests for anti-Cysticercus antibodies detection in serum and in CSF, in attempting to reach correct diagnosis.     

High numbers of perforin mRNA expressing CSF cells in multiple sclerosis patients with gadolinium-enhancing brain MRI lesions

Enhanced expression of pro- and anti-inflammatory cytokines is a common finding in MS, but attempts to correlate cytokine expression with disease activity have produced conflicting results. In this paper, gadolinium-(Gd-)enhancing lesions on brain MRI were used as markers for active inflammation in patients with MS not treated with any immunomodulatory drugs. In parallel, in situ hybridization was used to detect blood and cerebrospinal fluid (CSF) mononuclear cells (MNC) expressing cytokine mRNA. An association was observed between numbers of perforin mRNA expressing CSF MNC and numbers of Gd-enhancing brain MRI lesions. Perforin mRNA expressing CSF MNC were not detected in any of the patients lacking active lesions on brain MRI. The expression of tumor necrosis factor-alpha, interleukin-10 (IL-10) and IL-12 mRNA in CSF MNC did not differ between MS patients with and without active MRI lesions. Based on the present finding, a role for perforin in the disruption of the blood-brain barrier in MS can be hypothesized.