模拟多系统萎缩的抗Homer3抗体相关自身免疫性小脑共济失调1例并文献复习

doi:10.6040/j.issn.1671-7554.0.2024.1426

摘要/Abstract

摘要： 目的通过报道特殊病例并文献复习提高临床对抗Homer3抗体相关自身免疫性小脑共济失调与多系统萎缩-小脑型(cerebellar-type multiple system atrophy, MSA-C)的鉴别诊断意识。方法患者,女,61岁,病程呈2年内进行性加重,主要临床表现为头晕、共济失调及构音障碍。通过血清及脑脊液检测证实抗Homer3抗体IgG阳性,经静脉滴注甲泼尼龙治疗后症状显著改善。结果患者经免疫治疗后小脑症状明显缓解,其病程演变与治疗反应特征表明抗Homer3抗体相关自身免疫性小脑共济失调在临床表现上可与MSA-C高度相似。结论本病例提示在诊断MSA-C前需全面排查自身免疫性小脑共济失调等可治性疾病。两种疾病预后差异显著,部分自身免疫性小脑共济失调患者通过足量足疗程激素治疗可获得症状改善,及时准确诊断对改善患者预后具有重要临床意义。

关键词: 小脑共济失调, 自身免疫性, 多系统萎缩, 鉴别诊断

Abstract: Objective To enhance clinical awareness of differential diagnosis between anti-Homer3 antibody-associated autoimmune cerebellar ataxia and cerebellar-type multiple system atrophy(MSA-C)through reporting a special case and literature review. Methods A 61-year-old female patient presented with progressive worsening over two years, manifesting as dizziness, ataxia, and dysarthria. Serum and cerebrospinal fluid analyses confirmed positive anti-Homer3 IgG antibodies, with significant symptom improvement following intravenous methylprednisolone therapy. Results Post-immunotherapy cerebellar symptom remission was observed, and the disease progression pattern combined with treatment response characteristics demonstrated that anti-Homer3 antibody-associated autoimmune cerebellar ataxia could closely mimic MSA-C in clinical presentation. Conclusion This case highlights the necessity of comprehensive exclusion of treatable disorders like autoimmune cerebellar ataxia before diagnosing MSA-C. The significant prognostic differences between these conditions emphasize that timely and accurate diagnosis hold crucial clinical significance, as some autoimmune cerebellar ataxia patients may achieve symptomatic improvement through adequate corticosteroid therapy.

Key words: Cerebellar ataxia, Autoimmune, Multiple system atrophy, Differential diagnosis

中图分类号:

R742

魏旭鹏,常成,赵秀鹤. 模拟多系统萎缩的抗Homer3抗体相关自身免疫性小脑共济失调1例并文献复习[J]. 山东大学学报 (医学版), 2025, 63(5): 95-100.

WEI Xupeng, CHANG Cheng, ZHAO Xiuhe. A case report and literature review of anti-Homer3 antibody-associated autoimmune cerebellar ataxia mimicking multiple system atrophy[J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 95-100.

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