环磷酰胺序贯治疗儿童抗N-甲基-D-天冬氨酸受体脑炎的疗效及安全性分析

发布时间：2018-06-25 16:06

本文选题：抗N-甲基-D-天冬氨酸受体脑炎 + 环磷酰胺　；参考：《中国当代儿科杂志》2017年06期

【摘要】：目的分析环磷酰胺作为二线药物治疗儿童抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的疗效及安全性。方法 6例激素和丙种球蛋白冲击治疗效果欠佳的抗NMDAR脑炎患者序贯给予环磷酰胺治疗,进行疗效观察及安全性随访。结果 6例患儿经一线免疫治疗1~4周后,在精神症状、癫vN发作、不自主运动方面症状减轻;3例意识水平有所改善,能进行简单对答;所有患儿均仍有明显的反应迟钝,失语、失读、失写、失算、失用、运动障碍等高级皮层功能受损症状。予环磷酰胺序贯治疗,7 d内6例患儿均能进行简单对答;2~3周后3名学龄期患儿能进行简单计算,读写能力有较大改善,生活自理能力基本恢复;2~3个月后,6例患儿认知功能均基本恢复至病前水平,生活能力恢复正常。无不良反应发生及血常规、肝肾功能异常。结论儿童抗NMDAR脑炎确诊后应及早给予免疫治疗,环磷酰胺序贯治疗效果良好,不良反应少,安全性高。
[Abstract]:Objective to evaluate the efficacy and safety of cyclophosphamide (cyclophosphamide) as a second line drug in the treatment of NMDAR encephalitis in children. Methods six patients with NMDAR encephalitis were treated with cyclophosphamide. Results after 1 to 4 weeks of first-line immunotherapy, the mental symptoms, seizures of epileptic vN and involuntary motor symptoms were alleviated in 3 cases. Loss of reading, dyslexia, miscalculation, apraxia, motor disorders and other advanced cortical dysfunction symptoms. Within 7 days of sequential treatment with cyclophosphamide, 3 school-age children were able to perform simple calculation after 3 weeks of simple answer, and their reading and writing abilities were improved greatly. After 2 ~ 3 months, the cognitive function of 6 children recovered to the pre-illness level, and the ability of life returned to normal. No adverse reaction and blood routine, abnormal liver and kidney function. Conclusion Children with NMDAR encephalitis should be given immunotherapy as soon as possible. Cyclophosphamide sequential therapy has good effect, less adverse reactions and high safety.
【作者单位】：广州医科大学附属第二医院神经内科;
【分类号】：R742.9

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