48例临床拟诊为病毒性脑炎的抗NMDAR脑炎10例回顾性诊断分析  

Retrospective analysis of NMDAR antibodies in 48 patients with possible virus encephalitis

作　　者：黄磊[1] 梁波[1] 李雪莲[1] 王尚培 徐仿成[1] 陈先文[1] 

机构地区：[1]安徽医科大学第一附属医院神经内科,安徽合肥230022

出　　处：《中风与神经疾病杂志》2015年第9期793-796,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探究临床拟诊病毒性脑炎患者中N-甲基-D-天冬氨酸受体（N-methyl-D-aspartate receptor,NMDAR）抗体的阳性率并总结分析其临床特点。方法荧光免疫法回顾性检测我科过去2 y中48例临床拟诊病毒性脑炎患者脑脊液NMDAR抗体,总结分析NMDAR抗体阳性患者临床资料、影像、电生理及实验室检查等资料。结果 48例临床拟诊病毒性脑炎患者中10例NMDAR抗体阳性（20.8%）,修正诊断为抗NMDAR脑炎。男性6例,女性4例,年龄16~70岁。8例有发热、上呼吸道感染或腹泻等前驱感染症状。首发症状中癫痫发作及精神行为异常各有4例,余2例以头痛或意识障碍为首发症状。临床表现与病毒性脑炎类似,主要表现有发热（8例）、精神行为异常（7例）、癫痫发作（6例）、头痛（5例）、意识障碍（4例）及口角及四肢不自主运动（2例）。1例头部磁共振T2及FLAIR像可见边缘叶点片状高信号。9例脑电图不同程度异常。6例脑脊液细胞学示淋巴细胞反应。结论抗NMDAR脑炎临床表现与病毒性脑炎相似,易被误诊。临床上对病因不明的拟诊病毒性脑炎患者应行NMDAR抗体检查,以明确诊断。Objective To summarize and analyze the clinical,imaging, electroencephalogram and CSF cytology fea- tures of Anti-NMDA-receptor（NMDAR） encephalitis. Methods CSF of 48 patients diagnosed as possible viral encephali- tis in our department in the past 2 years were retrospectively examed for NMDAR antibody by method of fluorescence immu- noassay, and the clinical data of patients with positive result of NMDAR antibody were collected and analyzed. Results 10 of 48 patients previously diagnosed as possible viral encephalitis were found to be positive in NMDAR antibody detection of CSF,with a male：female ratio of 6：4 ,aged 17 to 70 years. Eight cases had prodromal symptoms consisting of fever,upper respiratory-tract symptoms and diarrhea. The most common initial symptoms were psychiatric disturbance （4 cases） and epi- leptic seizure （4 cases）, two cases started with headache or disturbance of consciousness. The general clinical features were similar to viral encephalitis, symptoms and signs consisted of fever （ 8 cases）, psychiatric disorder （7 cases）, epileptic sei- zure （ 6 cases）, headache （ 5 cases ）, disturbance of consciousness （ 4 cases）, involuntary movements of the limbs （ 2 cases ）. Brain MRI of one patient showed T2 and FLAIR abnormal hypefintensity signal in the limbic lobe. The majority EEG tests （9 cases）were abnormal. Cerebrospinal fluid cytology showed lymphocyte reaction （6 cases）. Conclusion The clinical manifestations of anti-NMDAR encephalitis and viral encephalitis are similar. Anti-NMDAR encephalitis should be suspec- ted in unknown etiology of encephalitis, and NMDAR antibody detection should be performed to confirm the diagnose.

关 键 词：NMDAR脑炎 拟诊病毒性脑炎 临床特点 细胞学 影像学 脑电图 

分 类 号：R512.3[医药卫生—内科学]