抗NMDA受体脑炎60例临床特点及预后分析

发布时间：2018-05-23 07:37

本文选题：抗NMDAR脑炎 + 临床特点　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:分析抗NMDAR脑炎在儿童和成人的临床表现、辅助检查、治疗方案、预后,重点比较儿童和成人抗NMDAR脑炎在临床表现、预后的差异,以加深对抗NMDAR脑炎的了解。方法:收集2014年01月至2017年3月于广西医科大学第一附属医院及第二附属医院神经内科、儿科住院诊断为抗NMDAR脑炎60例患者纳入本研究。并且对符合纳入标准的60例患者进行回顾性分析,收集其人口学资料、病史、临床表现、实验室检查、影像学检查及治疗效果等资料。将年龄≤14岁归为儿童组,年龄14岁为成人组,分别总结两组病人的临床特点及比较儿童、成人在临床表现及预后方面的差异。结果:⑴基本情况:60例抗NMDAR脑炎患者,其中男性31例,女性29例,男:女=6:5。其中成人组28例,儿童组32例,年龄区间为3-51岁,儿童组平均发病年龄为7.8±3.3岁,成人组平均发病年龄28.4±12.0岁。⑵前驱症状发生率:儿童组13例(40.6%),成人组13例(46.4%)。(3)首发症状以精神行为异常为首发症状:儿童组14例(43.8%)、成人组8例(28.6%);癫痫发作:儿童组7例(21.9%)、成人组7例(25%);精神行为异常+癫痫发作:儿童组6例(18.8%)、成人组7例(25%)。另外儿童组中3例(9.4%)以肢体无力为首发症状;成人组中记忆力、计算力下降3例(10.7%),双下肢乏力并行走不稳2例(7.1%)。以精神行为异常、癫痫发作、精神行为异常+癫痫发作为首发症状的抗NMDAR脑炎患者在儿童构成比与成年人构成比及男性构成比与女性构成比差异无统计学意义(P0.05)。⑶临床表现癫痫发作:儿童组23例(占71.8%)、成人组26例(92.9%);认知功能障碍:儿童组29例(90.6%)、成人组24例(85.7%);精神行为异常:儿童组中所有患儿均出现了不同类型的精神异常32例(100%)、成人组23例(占82.1%);中枢性低通气:儿童组3例(9.4%)、成人组21例(75%);运动障碍:儿童组27例(84.3%)、成人组20例(71.4%);自主神经功能障碍:儿童组20例(62.5%)、成人组20例(71.4%);意识障碍:儿童组16例(50%)、成人组14例(50%);疾病复发:儿童组12例(37.5%)、成人组2例(7.1%)。另外,儿童组中有30例(占93.7%)出现语言障碍、19例(59.3%)出现睡眠障碍;癫痫发作、精神异常、中枢性低通气、复发症状在儿童与成年人中发生概率比较,p0.05,差异有统计学意义。认知功能障碍、运动功能障碍、神经功能障碍、意识障碍临床表现在儿童与成年人中发生概率的比较,p0.05,差异无统计学意义。⑷辅助检查(1)脑脊液压力:儿童组脑脊液压力均正常,成人组中有8例升高(28.6%)。脑脊液常规、生化:儿童组异常6例、有核细胞数增多6例(18.8%)、蛋白升高1例(3.12%),成人组脑脊液常规异常表现为有核细胞数升高9例(32.1%),脑脊液蛋白升高3例(9.4%)。儿童组、成人组脑脊液糖氯均基本正常。儿童组脑脊液抗nmdar抗体阳性率为100%,血清抗nmdar抗体阳性24例(75%);脑脊液抗nmdar抗体阳性率为100%,血清抗nmdar抗体阳性率为22例(68.75%)。(2)脑电图:儿童组32例中有1例未行脑电图检查,脑电图异常31例(100%),全脑多部位δ刷4例(12.5%)。成人组脑电图异常28例(100%),典型的δ刷(edb)5例(15.6%)。(3)头颅mri/ct:儿童组:32例患儿有3例未行头颅mri或头颅ct检查,异常14例(48.3%)。成人组28例患者中有1例未行头颅ct/mri检查,异常13例(48.1%)。⑸预后:脑脊液抗nmdar抗体滴度1:10组vs1:16组,1:10组vs≥1:32组mrs评分t检验,p值0.05,差异有统计学意义。脑脊液抗nmdar抗体滴度1:16组vs≥1:32组mrs评分行t检验,p值0.05,差异无统计学意义。脑脊液抗nmdar抗体滴度1:10组vs1:16组、1:10组vs≥1:32组及1:16组vs≥1:32组时住院日进行t检验,p值均0.05,差异无统计学意义。出院时MRS≤2分的患者在儿童构成比与成人构成比及男性构成比与女性构成比差异无统计学意义(P0.05)。结论:⑴以精神行为异常、癫痫发作、精神行为异常+癫痫发作为首发症状的抗NMDAR脑炎患者在儿童构成比与成人构成比及男性构成比与女性构成比无差别。⑵儿童常见的症状:精神行为异常、语言障碍、认知功能障碍、运动障碍、癫痫发作、自主神经功能障碍、睡眠障碍、不同程度的意识水平下降。成人常见的症状:癫痫发作、认知功能障碍、精神行为异常、中枢性低通气、运动障碍、自主神经功能障碍、意识障碍。成人比儿童更容易发生癫痫、中枢性低通气,儿童相比成人易发生精神异常、疾病再次复发。认知功能障碍、运动功能障碍、神经功能障碍、意识障碍临床表现在儿童发与成年人中发生概率无差别别。(3)出院时MRS≤2分的患者在儿童构成比与成人构成比及男性构成比与女性构成比差异无统计学意义(P0.05)。脑脊液抗NMDAR抗体滴度1:10组比1:16组、≥1:32组预后好,脑脊液NMDAR抗体滴度1:16组与≥1:32组预后无差异。
[Abstract]:Objective: to analyze the clinical manifestations, auxiliary examination, treatment and prognosis of anti NMDAR encephalitis in children and adults, and to compare the clinical manifestations and prognosis of anti NMDAR encephalitis in children and adults in order to deepen the understanding of NMDAR encephalitis. Methods: to collect the First Affiliated Hospital of Guangxi Medical University and the second affiliated medicine from 01 to March 2017 2014. In the Department of Neurology, 60 patients with anti NMDAR encephalitis were included in the Department of Pediatrics, and 60 patients who were in conformity with the inclusion criteria were retrospectively analyzed, and their demographic data, medical history, clinical manifestation, laboratory examination, imaging examination and treatment effect were collected. The age of age less than 14 years old was classified as a child group, and the age of 14 years as an adult group. The clinical characteristics of two groups of patients and the difference of children and adults in clinical manifestation and prognosis were compared. Results: (1) basic situation: 60 cases of anti NMDAR encephalitis, including 31 cases of male and 29 women, 28 cases in adult group, 32 cases in children group, 3-51 years in age area, and 7.8 + 3.3 years old in the children group. The average age of onset was 28.4 + 12 years. (2) the incidence of prodrome symptoms: 13 cases (40.6%) in children group and 13 cases in adult group (46.4%). (3) the first symptom was the first symptom of abnormal mental behavior: 14 cases in children group (43.8%), 8 in adult group (28.6%); epileptic seizures: children group 7 (21.9%), adult group, epileptic seizure: children group 8.8%), in the adult group, 7 cases (25%). In addition, 3 cases (9.4%) in the children group were the first symptom of limb weakness; in the adult group, 3 cases (10.7%), 3 lower extremities and unstable walking (7.1%) were found in the adult group. The patients with anti NMDAR encephalitis with mental and behavioral abnormalities, epileptic seizures, and mental behavior abnormal + epilepsy were formed in children's composition ratio. There was no significant difference in the proportion of adult constitution ratio and male constitution ratio (P0.05). (3) the clinical manifestations of epilepsy were 23 cases (71.8%) in children group, 26 cases in adult group (92.9%), 29 cases in children (90.6%), 24 in adult group (85.7%), and 24 in adult group (85.7%); all children in the children group had different types of sperm. There were 32 cases of deity (100%), 23 cases in adult group (82.1%), 3 cases in children group (9.4%), 21 cases in adult group (75%), 27 cases in children group (84.3%), 20 in adult group (71.4%); autonomic nervous dysfunction: pediatric group 20 cases (62.5%), adult group, adult group, adult group; disease recurrence: There were 12 cases (37.5%) in children and 2 cases (7.1%) in adult group. In addition, 30 cases (93.7%) had language disorder, 19 cases (59.3%) had sleep disorder, epileptic seizures, psychosis, central hypoventilation, and the incidence of recurrent symptoms in children and adults, P0.05, there was statistical significance. Cognitive dysfunction, motor dysfunction, The clinical manifestations of neural dysfunction and disturbance of consciousness were compared in children and adults. There was no statistical difference in P0.05. (1) cerebrospinal fluid pressure in children was normal, 8 cases in the adult group increased (28.6%). Cerebrospinal fluid routine, biochemistry: 6 cases in children group and 6 cases of nuclear cells (18.8%). The protein increased in 1 cases (3.12%). The normal abnormal cerebrospinal fluid in the adult group was 9 cases (32.1%) and 3 cases of cerebrospinal fluid protein (9.4%). In the children group, the cerebrospinal fluid glucose and chloride in the adult group were basically normal. The anti NMDAR antibody positive rate of the cerebrospinal fluid in the children group was 100%, the serum anti NMDAR antibody positive was 24 cases (75%), and the positive rate of anti NMDAR antibody in cerebrospinal fluid was the positive rate in the cerebrospinal fluid. 100%, the positive rate of serum anti NMDAR antibody was 22 cases (68.75%). (2) electroencephalogram: 1 cases in 32 cases of children were not examined by electroencephalogram, 31 cases of electroencephalogram (100%), 4 (12.5%) with delta brush in the whole brain (12.5%), 28 (100%) in adult group and typical delta brush (68.75%). Cranial CT examination, abnormal 14 cases (48.3%). 28 cases in adult group had 1 cases without head ct/mri examination, abnormal 13 cases (48.1%). The prognosis of anti NMDAR antibody titer in cerebrospinal fluid at 1:10 group was vs1:16 group, vs above Mrs score of vs in 1:10 group and P value 0.05, the difference was statistically significant. Mrs score of vs of anti NMDAR antibody titer group of cerebrospinal fluid was tested for t test. The p value was 0.05, the difference was not statistically significant. The anti NMDAR antibody titer in the cerebrospinal fluid was in the vs1:16 group at 1:10 group, in the 1:10 group, and in the group of vs more or more than in the group vs, and the p value was 0.05, the difference was not statistically significant. There was no difference in the ratio of the constitution ratio of the children with the adult to the adult constitution and the ratio of the male constitution to the female constitution. Statistical significance (P0.05). Conclusion: (1) there is no difference in the ratio of the composition ratio of the children to the adult constitution ratio and the male constitution ratio and the female constitution ratio with the mental behavior abnormalities, the epileptic seizures, the mental behavior abnormal + epilepsy as the first symptom. (2) the common symptoms of children: mental and behavioral disorders, language disorders, cognitive dysfunction, transportation. Dyskinesia, epileptic seizures, autonomic nervous dysfunction, sleep disorders, and lower levels of consciousness. Common symptoms in adults: epileptic seizures, cognitive dysfunction, abnormal mental behavior, central hypoventilation, dyskinesia, autonomic dysfunction, disturbance of consciousness. Adults are more prone to epilepsy, central hypoventilation than children. There is no difference in the incidence of cognitive dysfunction, motor dysfunction, neurological dysfunction, and consciousness disorder in children's hair and adults. (3) the ratio of MRS to 2 in the discharge of children is compared with the proportion of the adult constitution ratio and the male constitution ratio and the female constitution ratio. There was no statistical significance (P0.05). The anti NMDAR antibody titer in cerebrospinal fluid at 1:10 group was better than that in the 1:16 group, and the prognosis was better than that of the group. There was no difference in the prognosis of the NMDAR antibody titer in cerebrospinal fluid and the prognosis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.9

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