抗NMDA受体脑炎15例临床分析

发布时间：2018-04-14 09:09

本文选题：抗NMDA受体脑炎 + 脑电图　；参考：《重庆医科大学》2016年硕士论文

【摘要】：目的:探讨15例抗NMDA受体脑炎的临床特点。方法:回顾性分析我院神经内科2014年6月至2015年12月确诊的15例抗NMDA受体脑炎患者的临床资料并进行随访。采用SAS软件进行t检验和Fisher精确检验。结果:本组15例抗NMDA受体脑炎患者年龄17~60岁,女性10例、男性5例,6例有前驱症状。首发症状以精神行为异常者12例、抽搐者2例、不自主运动者1例。病程中出现精神行为异常者15例,抽搐者13例,不自主运动者11例,意识障碍和肌张力障碍者各10例,自主神经功能紊乱7例,记忆障碍和低通气者各6例,言语障碍者4例。所有患者脑脊液中NMDA受体的NR1 IgG抗体阳性;脑电图异常14例,以慢波及慢波活动最常见,其中2例存在δ刷;脑脊液常规、生化异常者9例,头颅MRI异常者5例,3例筛查出可疑肿瘤。9例行静脉注射免疫球蛋白联合激素治疗、5例仅行激素治疗、1例仅对症治疗。随访3-21月,9例恢复正常或基本正常,2例死亡,3例复发,1例预后不详。结论:抗NMDA受体脑炎以年轻女性多发,精神行为异常多为首发症状,多数患者在发病1月内出现3组及以上症候群。脑脊液常规、生化、头颅MRI常无特异性,脑电图以慢波及慢波活动最常见,部分出现δ刷状波。多数患者行激素和/或静脉注射免疫球蛋白治疗。60%的患者预后较好,部分出现复发,未发现肿瘤的患者复发率较高。
[Abstract]:Objective: to investigate the clinical features of 15 cases of anti-NMDA receptor encephalitis.Methods: the clinical data of 15 patients with anti NMDA receptor encephalitis from June 2014 to December 2015 were retrospectively analyzed and followed up.T test and Fisher accurate test were carried out by SAS software.Results: the age of 15 patients with anti NMDA receptor encephalitis was 1760 years old, 10 female patients and 6 male patients with prodromal symptoms.The first symptom was abnormal mental behavior in 12 cases, convulsion in 2 cases and involuntary exercise in 1 case.There were 15 cases of abnormal mental behavior, 13 cases of convulsion, 11 cases of involuntary movement, 10 cases of consciousness disorder and muscular dystonia, 7 cases of autonomic nervous dysfunction, 6 cases of memory disorder and hypopnea, 4 cases of speech disorder.NR1 IgG antibody of NMDA receptor was positive in cerebrospinal fluid of all patients, EEG abnormality was found in 14 cases, slow wave activity was the most common, among them, 未 brush was found in 2 cases, cerebrospinal fluid routine, biochemical abnormality in 9 cases.5 cases with abnormal cranial MRI and 3 cases with suspicious tumor were screened out. 9 cases were treated with intravenous immunoglobulin combined with hormone therapy. 5 cases were treated only with hormone therapy and 1 case was treated only with symptomatic therapy.9 cases returned to normal or 2 cases died from 3 to 21 months after follow-up. The prognosis of 1 case was unknown.Conclusion: anti NMDA receptor encephalitis is more common in young women, and abnormal mental behavior is the first symptom. Most of the patients have 3 or more syndrome groups within one month after onset of NMDA encephalitis.Cerebrospinal fluid (CSF) was routine, biochemical, and MRI was not specific. Slow wave and slow wave activity were most common in EEG, and 未 brushed wave was found in part of EEG.Most patients were treated with hormone and / or intravenous immunoglobulin. 60% of the patients had better prognosis and some recurrence. The recurrence rate of the patients without tumor was higher.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R742.9

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