儿童抗N-甲基-D-天冬氨酸受体脑炎临床与脑电图分析  

Clinical and electroencephalographic analysis of anti-N-methyl-D-aspartate receptor encephalitis in children

作　　者：李华[1] 王晓慧[1] 方方[1] 丁昌红[1] 吕俊兰[1] 陈春红[1] 韩彤立[1] 伍妘[1] 张炜华[1] 李久伟[1] 王红梅[1] 杨欣英[1] 张珅[1] 邓劼[1] 巩帅[1] 孙欣[1] 代丽芳[1] 

机构地区：[1]首都医科大学附属北京儿童医院神经内科,100045

出　　处：《中华儿科杂志》2016年第7期510-514,共5页Chinese Journal of Pediatrics

摘　　要：目的 总结儿童抗N-甲基-D-天冬氨酸（NMDA）受体脑炎的临床与脑电图特征.方法 回顾性分析2011年8月至2015年3月在首都医科大学附属北京儿童医院神经内科确诊并住院治疗的105例抗NMDA受体脑炎患儿的临床与脑电图资料.105例患儿中男38例、女67例,发病年龄为6月龄至15岁8个月,平均（8＆#177;4）岁;确诊时间4～850 d,中位数24.5 d.根据改良的Rankin量表对患儿进行病情评估,同时进行持续脑电图监测,对监测结果进行分析总结.结果 105例患儿中病情轻、中、重度者分别为12、65和28例.91例（86.7％）患儿脑电图异常,其中背景活动减慢28例（26.7％）,广泛性或弥漫性慢波25例（23.8％）,限局性慢波33例（31.4％）,癫痫样波形41例（39.O％）.10例患儿（9.5％）在睡眠非快速眼运动（NREM）期呈现单侧或弥漫性α-θ频段节律,7例（6.7％）存在极度δ刷状波（EDB）.病情轻、中和重3组间脑电图异常分别为5例、58例（89.2％）和28例（100.0％）,7例EDB现象患儿均为重度组,10例异常α-θ节律患儿均为中度组.结论 儿童抗NMDA受体脑炎脑电图表现符合一般脑炎的脑电图改变,且脑电图异常程度与病情严重程度成正比.脑电图出现EDB现象和异常α-θ节律对本病诊断及病情的严重性均有提示作用.Objective To study the clinical and electroencephalographic （EEG） characteristics of anti-N-methyl-D-aspartate receptor encephalitis （anti-NMDARencephalitis） in children.Method Retrospective analysis was performed on the clinical and EEG data of 105 patients with anti-NMDAR encephalitis treated in Beijing Children＆#39;s Hospital （August 2011-March 2015）.Of the 105 patients,38 were male and 67 were female.The age of onset was from 6 months and 26 days to 15 years and 8 months （average （8＆#177;4）years）.The time for confirmed diagnosis was from 4 days to 850 days （median 24.5 days）.According to the modified Rankin scales,the patient＆#39;s clinical conditions were assessed and underwent continuous EEG （cEEG） monitoring.The data were reviewed and analyzed.Result Based on the severity of the disease,the 105 patients were divided into three groups：mild group （12 cases）,moderate group （65 cases）,and severe group （28 cases）.There were 91 cases （86.7%） with abnormal EEG patterns,including 28 cases （26.7%） with slow background activity in EEG,25 cases （23.8%） with generalized or diffuse slow waves,33 cases （31.4%） had focal slow waves,41 cases （39.0%） had epileptic waves;10 cases （9.5%） showed unilateral or diffuse alpha-theta band rhythms in nonrapid eye movement （NREM） sleep,7 cases （6.7%） showed extreme delta brush waves （EDB）.Accordingly,the number of patients with abnormal EEG in mild,moderate and severe groups was 5,58 （89.2%） and 28 （100.0%）.Seven patients with EDB phenomenon were all in the severe group,and 10 patients with abnormal alpha-theta band rhythms were in the moderate group.Conclusion In children with anti-NMDAR encephalitis,the EEG patterns are in line with the changes of EEG in general encephalitis.The extent of EEG abnormalities correlates with the clinical severity of the disease.Extreme delta brush and alpha-theta band rhythms may be suggestive of diagnosis and clinical assessment of the disease.

关 键 词：受体 N-甲基-D-天冬氨酸 脑炎 脑电描记术 儿童 

分 类 号：R742.9[医药卫生—神经病学与精神病学]