抗N-甲基-D-天冬氨酸受体脑炎2例报道并文献复习

发布时间：2018-05-13 22:39

本文选题：抗N-甲基-D-天冬氨酸 + 脑炎　；参考：《中风与神经疾病杂志》2015年03期

【摘要】：目的探讨抗N-甲基-D-天冬氨酸受体脑炎患者的临床特点及诊治。方法收集2例我院诊治的抗N-甲基-D-天冬氨酸受体脑炎患者的临床资料,并通过计算机检索中国知网、万方数据库,收集2010年至2013年在我国各种期刊上公开发表的关于抗N-甲基-D-天冬氨酸受体脑炎患者的文献。结果本文报道的2例及9篇文献检索的23例患者主要表现为发热、精神行为异常、智能减退、抽搐、不自主运动及表现为睡眠减少、心率快、汗液分泌异常等自主神经功能障碍。本文报道的2例患者男女各1例,年龄分别为15.5岁、14岁,均未发现畸胎瘤;文献检索的23例患者女性14例、男性9例,合并畸胎瘤5例。所有病例均经化验血液和(或)脑脊液抗NMDA受体抗体阳性而确诊,脑脊液可见以淋巴细胞为主的白细胞数轻度升高。头MRI检查及脑电图无特异性所见。本文报道的2例患者尚发现血液抗链球菌溶血素O均升高。本文报道的2例患者及文献检索的20例患者经大剂量激素联合丙种球蛋白治疗后(20/23,86.9%)症状明显改善,2例症状改善不明显,1例死亡。结论抗N-甲基-D-天冬氨酸受体脑炎临床表现无特异性,早期易误诊为精神障碍性疾病,脑脊液抗NMDA受体抗体检测有助于早期诊断和治疗,大部分患者免疫治疗有效。本文报道的2例病例尚合并ASO升高,文献中未见报道。
[Abstract]:Objective to investigate the clinical features, diagnosis and treatment of anti-N-methyl-d-aspartic acid receptor encephalitis. Methods the clinical data of 2 patients with N- methyl-Daspartic acid receptor encephalitis treated in our hospital were collected. The literature on patients with N- methyl-Daspartic acid receptor encephalitis was collected and published in various Chinese journals from 2010 to 2013. Results two cases and 23 cases were reviewed in this paper. The main symptoms were fever, abnormal mental behavior, decreased intelligence, convulsion, involuntary movement, decreased sleep and fast heart rate. Dysfunction of autonomic nervous system such as abnormal sweat secretion. Two patients, one male and one male, aged 15.5 years and 14 years old, were reported in this paper, none of whom were found teratoma, and 23 cases were female, 9 male and 5 complicated teratoma. All cases were confirmed by blood and / or cerebrospinal fluid anti NMDA receptor antibody positive, cerebrospinal fluid (CSF) showed a slight increase in the number of white blood cells, mainly lymphocytes. There were no specific findings in head MRI and EEG. Two cases of hemolysin O were found to be elevated in the blood of anti-streptococcal hemolysin. Two patients reported in this paper and 20 patients reviewed in literature were treated with high-dose hormone combined with gamma globulin (20 / 2386.9). Conclusion the clinical manifestations of anti-N- methyl-Daspartic acid receptor encephalitis are nonspecific and easily misdiagnosed as mental disorders in early stage. The detection of anti NMDA receptor antibody in cerebrospinal fluid is helpful for early diagnosis and treatment. Immunotherapy is effective in most patients. Two cases reported in this paper were still complicated with ASO elevation, which was not reported in the literature.
【作者单位】：辽宁省人民医院神经内科;
【分类号】：R512.3

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