BRAIN and NERVE－神経研究の進歩65巻4号

2013年04月発行

増大特集 Antibody Update

自己免疫性ニューロパチーと抗糖脂質抗体

著者： 海田賢一¹ 楠進²

所属機関： ¹防衛医科大学校内科学3神経内科 ²近畿大学医学部神経内科

ページ範囲：P.413 - P.423

文献概要

はじめに

　ニューロパチーを呈するパラプロテイン血症患者において，血清IgMがヒトミエリン関連糖蛋白および糖脂質糖鎖に反応することが1984年に見出されて以来¹⁾，自己免疫性ニューロパチーにおいてヒト末梢神経成分の糖鎖に対する自己抗体が広く検索されてきた。特にギラン・バレー症候群（Guillain-Barré syndrome：GBS）ではシアル酸を持つ糖脂質であるガングリオシドに対する抗体の病的意義に関する研究が精力的に行われ，補体介在性神経障害などの神経障害機序が明らかにされつつある。同様に慢性炎症性脱髄性多発根神経炎（chronic inflammatory demyelinating polyradiculoneuropathy：CIDP）をはじめとする慢性自己免疫性ニューロパチーにおいても糖鎖に対する自己抗体が検索されてきたが，現在の段階ではその出現頻度も低く病的意義は明らかになっていない。近年では抗糖脂質抗体以外にランヴィエ絞輪を構成する膜蛋白を標的とする抗体も検索されつつある。本稿では，これらの自己免疫性ニューロパチー，特にGBSとその亜型における抗糖脂質抗体の病的意義に関して，最近の知見を加えて解説する。

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