抗N-甲基-D-天门冬氨酸受体脑炎39例临床特点分析

发布时间：2018-08-31 07:47

【摘要】：目的:了解抗N-甲基-D-天门冬氨酸受体(NMDAR)脑炎患者的发病症状、检验检查、治疗及预后等临床特点,为更好的早期诊断抗NMDAR脑炎提供依据及思路。方法:回顾性分析39例诊断为抗NMDAR脑炎的患者病历资料,分析总结其临床特点、治疗及预后。结果:39例患者中,男23例(59.0%),女16例(41.0%),年龄为4~59岁,平均(28.3±13.7)岁。20例(51.3%)伴有不同程度的前驱症状,首发症状多为精神行为异常(46.2%)及癫痫发作(43.6%),有意识障碍14例(35.9%),记忆力减退4例(10.3%),锥体外系症状3例(7.7%)。39例患者脑脊液中抗NMDAR抗体均阳性(100.0%),血清检测9例(23.1%)阳性。头颅MRI表现14例异常(35.9%)。脑脊液病毒抗体6例(15.4%)阳性。脑电图慢波增多5例(12.8%),可见棘波、尖波3例(7.7%)。均给予丙种球蛋白、激素或免疫抑制剂治疗。随访3个月至2年,1例(2.6%)死亡,4例(10.3%)症状无改善,12例(30.8%)症状完全缓解,22例(56.4%)症状稍改善继续药物治疗中。结论:全面认识并掌握抗NMDAR脑炎的临床特点,早期诊治,合理用药,有利于改善患者预后并降低病死率。
[Abstract]:Objective: to investigate the symptoms, examination, treatment and prognosis of patients with anti-N- methyl-Daspartate receptor (NMDAR) encephalitis, and to provide evidence and ideas for the early diagnosis of anti-N- D- aspartate receptor (NMDAR) encephalitis. Methods: the data of 39 patients with anti NMDAR encephalitis were analyzed retrospectively. Results among the 39 patients, 23 were male (59.0%), 16 were female (41.0%), the age was 459 years old. The mean age was (28.3 卤13.7) years old. 20 patients (51.3%) had different degrees of prodromal symptoms. Most of the initial symptoms were abnormal mental behavior (46.2%) and seizures (43.6%), conscious disorder in 14 cases (35.9%), memory loss in 4 cases (10.3%), extrapyramidal symptoms in 3 cases (7.7%) .39 cases of cerebrospinal fluid (100.0%) were positive for anti NMDAR antibody, and 9 cases (23.1%) were positive in serum. MRI findings were abnormal in 14 cases (35.9%). Cerebrospinal fluid virus antibody was positive in 6 cases (15.4%). EEG slow wave increased in 5 cases (12. 8%), spike wave in 3 cases (7. 7%) and spike wave in 3 cases (7. 7%). All patients were treated with gamma globulin, hormone or immunosuppressant. 1 case (2.6%) died from 3 months to 2 years, 4 cases (10.3%) had no improvement of symptoms, 12 cases (30.8%) had complete remission of symptoms, 22 cases (56.4%) had symptoms improved slightly. Conclusion: comprehensive understanding and mastering the clinical characteristics of NMDAR encephalitis, early diagnosis and treatment, rational use of drugs can improve the prognosis of patients and reduce the fatality rate.
【作者单位】：第四军医大学西京医院神经内科;西安市儿童医院神经内科;陕西省人民医院神经内科;
【分类号】：R742.9

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