Retrospective analysis of protein A column immunoadsorption in the treatment of refractory anti-N-methyl-D-aspartate receptor encephalitis in children
10.3760/cma.j.issn.1673-4912.2025.01.007
- VernacularTitle:蛋白A免疫吸附治疗儿童难治性抗N-甲基-D-门冬氨酸受体脑炎的回顾性分析
- Author:
Ying WANG
1
;
Le MA
;
Zhangyan GUO
;
Yanqiang DU
;
Hua ZHANG
;
Weikai WANG
;
Yi WANG
Author Information
1. 国家儿童区域医疗中心（西北）西安交通大学附属儿童医院 西安市儿童医院儿童重症医学科710003
- Publication Type:Journal Article
- Keywords:
Protein A column immunoadsorption;
Children;
Anti-N-methyl-D-aspartate receptor encephalitis
- From:
Chinese Pediatric Emergency Medicine
2025;32(1):33-37
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the safety and efficacy of immunoadsorption with protein A column(PA-IA) in refractory anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children.Methods:The clinical data of 8 children with anti-NMDAR encephalitis who failed to receive first-line treatment from January 2022 to June 2023 in PICU of Xi'an Children's Hospital were retrospectively collected.Clinical features,modified Rankin score (mRS),anti-NMDAR antibody titers in serum and cerebrospinal fluid(CSF),cells count in CSF,protein level in CSF,serum IgG,complement C3,C4 level were analyzed before and after immunoadsorption therapy. All adverse events that occurred during treatment were recorded in detail.Result:Among the 8 children,there were 5 males and 3 females,aged 5 to 12 years old,and each patient was immunized 6 to 10 times,and 75 times of PA-IA treatment were performed. The mRS score decreased in 8 children after PA-IA treatment. Blood IgG level,CSF cell number,protein level in CSF,blood complement C3 and C4 levels,and antibody titers related in blood and CSF were all lower than those before PA-IA treatment. The differences were all statistically significant ( P<0.001).During 75 times of treatment,only 1 case of membrane rupture occurred during treatment,the treatment was stopped and continued after the plasma separator was replaced,with no other adverse reactions. Conclusion:PA-IA could effectively improve the clinical symptoms and neurological function of children with refractory anti-NMDAR encephalitis with good safety,but its exact efficacy in children with anti-NMDAR encephalitis needs to be verified by prospective studies with larger samples.
