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目的 分析抗神经束蛋白155(NF155)抗体阳性自身免疫性郎飞结旁病误诊为腰椎间盘突出症的原因，以提高对该病认识，降低临床误诊率。方法 对2024年7月被误诊的1例抗NF155抗体阳性自身免疫性郎飞结旁病患者的临床资料进行回顾性分析，复习相关文献。结果 患者主因双下肢麻木1年余，加重伴腰痛、双下肢疼痛15 d就诊于骨科门诊，以“腰椎间盘突出症”收入院。腰椎磁共振成像未见明显神经根受压，止痛治疗症状无缓解，遂转入神经内科。后行脑脊液检测示蛋白明显升高，且有蛋白-细胞分离现象，肌电图示以双下肢L4～S1神经根支配区慢性损伤为主，双下肢交感神经功能障碍，脑脊液及血清抗NF155抗体检测阳性。明确诊断为抗NF155抗体阳性自身免疫性郎飞结旁病，误诊时间23 d。确诊后给予糖皮质激素治疗，随访2周，患者临床症状改善。结论 对临床表现为多发性运动感觉性周围神经病的慢性病程患者，应考虑自身免疫性郎飞结旁病可能，及时行相关抗体检测并排查其他病因，以明确诊断并早期治疗，争取较好预后。
Abstract：Objective To analyze the cause of misdiagnosis of anti-neurofascin 155(NF155) antibody positive autoimmune paranodopathy(APN) as lumbar disc herniation, so as to improve the understanding of this disease and reduce the clinical misdiagnosis rate. Methods The clinical data of a patient with anti-NF155 antibody positive APN who was misdiagnosed in July 2024 were retrospectively analyzed, and the relevant literature was reviewed. Results The patient was admitted to the orthopaedic clinic as "lumbar disc herniation" due to numbness in both lower limbs for more than 1 year and aggravation with lower back pain and lower limb pain for 15 d. Lumbar magnetic resonance imaging(MRI) did not show obvious nerve root compression, and symptoms did not relieve after pain therapy; therefore, the patient was transferred to the Department of Neurology. Subsequently, cerebrospinal fluid tests showed significant protein increase and protein-cell separation. The electromyography of both lower extremities showed chronic damage to the L4～S1 nerve root innervation area of both lower extremities, sympathetic nerve dysfunction of both lower extremities, and positive anti-NF155 antibody detection in cerebrospinal fluid and the serum. The patient was diagnosed with anti-NF155 antibody positive APN, and the misdiagnosis lasted 23 d. After diagnosis, the patient was given Glucocorticoid therapy and followed up for 2 weeks, and the clinical symptoms improved. Conclusion For chronic disease patients with clinical manifestations of multiple motor sensory peripheral neuropathy, the possibility of APN should be considered, and relevant antibody detection should be conducted and other etiologies should be ruled out, to make definite diagnosis and early treatment and achieve better prognosis.
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基本信息:
DOI：
中图分类号:R593.2
引用信息:
[1]徐秀红,矫树生,周毅等.抗NF155抗体阳性自身免疫性郎飞结旁病误诊为腰椎间盘突出症的原因分析[J].临床误诊误治,2025,38(10):31-37.
基金信息:
河北省医学科学研究重点科技研究计划课题(20231594)