抗NMDA受体脑炎临床相关研究分析

发布时间：2019-06-28 15:50

【摘要】：目的:探讨和分析本院抗N-甲基-D-天冬氨酸(N-Methyl-D-Aspartate,NMDA)受体脑炎患者的性别差异、临床表现、抗体滴度、影像学特点、脑电图特征、治疗及其对预后的影响。方法:收集2014年1月至2016年11月在浙江大学医学院附属第二医院住院治疗且-资料齐全的28例抗NMDA受体脑炎患者的临床资料,在出院后6个月这一时间节点进行跟踪随访,最后再结合相关文献对该疾病临床特点及预后做一总结。结果:28例抗NMDA受体脑炎患者中,男性患者和女性患者各14例。男性患者中有11例(78.6%)出现脑脊液有核细胞数增加,而女性患者仅有3例(21.4%)脑脊液有核细胞数增加,两组之前存在明显的差异(P0.05)。仅有6例(42.9%)女性患者的头颅MRI存在异常,而男性患者中有12例(85.7%)存在头颅MRI的异常,两组之间同样存在显著差异(P0.05)。两组的年龄分布、临床症状、脑电图结果之间无明显差异(P0.05)。不同预后的抗NMDA受体脑炎患者的脑脊液抗体滴度之间存在明显差异(P0.05),抗体滴度高的患者较抗体滴度低的患者而言,预后较差。结论:抗NMDA受体脑炎的临床表现大多数可逆,且具有一定的性别差异,脑脊液中抗体滴度越高提示预后越差。
[Abstract]:Objective: to investigate and analyze the gender difference, clinical manifestations, antibody titers, imaging features, electroencephalogram (EEG) features, treatment and prognosis of patients with anti-N-methyl-D-aspartate (NMDA) receptor meningitis. Methods: the clinical data of 28 patients with anti-NMDA receptor meningitis hospitalized in the second affiliated Hospital of Medical College of Zhejiang University from January 2014 to November 2016 were collected and followed up at this time point 6 months after discharge. Finally, the clinical characteristics and prognosis of the disease were summarized in combination with the relevant literature. Results: of the 28 patients with anti-NMDA receptor meningitis, 14 were male and 14 were female. The number of nucleated cells in cerebrospinal fluid increased in 11 cases (78.6%) of male patients and only 3 cases (21.4%) of female patients. There was significant difference between the two groups (P 0.05). Only 6 cases (42.9%) of female patients had abnormal skull MRI, while 12 cases (85.7%) of male patients had abnormal skull MRI, and there was also significant difference between the two groups (P 0.05). There was no significant difference in age distribution, clinical symptoms and electroencephalogram (EEG) between the two groups (P 0.05). There was significant difference in cerebrospinal fluid antibody titer among patients with different prognosis of anti-NMDA receptor meningitis (P 0.05). The prognosis of patients with high antibody titer was worse than that of patients with low antibody titer. Conclusion: most of the clinical manifestations of anti-NMDA receptor meningitis are reversible and have certain gender differences. The higher the antibody titer in cerebrospinal fluid, the worse the prognosis.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.9

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