抗NMDAR脑炎二例临床误诊分析  

Misdiagnosis Analysis of 2 Patients with Anti-NMDAR Encephalitis

作　　者：程娜 黄勇华 石文磊[3] CHENG Na HUANG Yong-hua SHI Wen-Lei(Department of Neurology, Langfang Changzheng Hospital, Langfang, Hebei 065000, China Department of Neurology, General Hospital of PLA Army, Beijing 10070, China Department of Neurology, Bethune International Peace Hospital PLA, Shijiazhuang 050082, China)

机构地区：[1]廊坊长征医院神经内科,河北廊坊065000 [2]陆军总医院神经内科,北京100700 [3]解放军白求恩国际和平医院神经内科,石家庄050082

出　　处：《临床误诊误治》2016年第12期41-44,共4页Clinical Misdiagnosis & Mistherapy

基　　金：陆军总医院创新基金(2015-LC-02)

摘　　要：目的 探讨抗N-甲基-D-天冬氨酸受体（N-methyl-D-aspartate receptor,NMDAR）脑炎的临床特征,减少误诊误治。方法 对我院近期收治的抗NMDAR脑炎2例的临床资料进行回顾性分析并复习相关文献。结果 本组2例因精神行为异常、意识障碍、癫痫发作就诊,例1曾按病毒性脑炎予抗病毒治疗;例2曾按分离性精神障碍予抗精神药物治疗。入我科后经综合分析,考虑自身免疫相关脑炎可能,行腰椎穿刺脑脊液及血液检查示NMDAR抗体均强阳性,确诊为抗NMDAR脑炎。予糖皮质激素、免疫球蛋白等治疗,例1合并畸胎瘤行手术切除后予利妥昔单抗、环磷酰胺及抗癫痫等对症治疗,后2例症状均明显改善出院。随访3个月~1年,例1畸胎瘤复发;例2病情出现反复,再次入院予对症治疗后好转出院。结论 抗NMDAR脑炎临床表现无特异性,易误诊。及时行相关抗体检测、伴有肿瘤者及时切除肿瘤并早期予免疫抑制剂是避免误诊误治的关键。Objective To investigate clinical features of anti-NMDAR（ N-methyl-D-aspartate receptor） encephalitis in order to reduce misdiagnosis and mistreatment. Methods Clinical data of 2 patients with anti-NMDAR encephalitis was retro-spectively analyzed, and relevant literature was reviewed. Results The 2 patients were admitted for mental and behavioral disorders, consciousness disorders and seizure disorder. One had been treated with antiviral therapy for diagnosis of viral en-cephalitis, while another has been treated with antipsychotic drugs for diagnosis of dissociative disorders. After they were ad-mitted to our department, lumbar puncture and blood test showed that anti-NMDAR antibodies were strongly positive after com-prehensive analysis of possibility of autoimmune encephalitis, and then anti-NMDAR encephalitis was confirmed. Treatments such as glucocorticoid and immune globulin were given, and one patient was treated with symptomatic treatments such as Rit-uximab, Cyclophosphamide and anti-epilepsy after surgical teratoma resection, while another patient was discharged after symptoms improvement. During follow-up for 3 months to 1 year, one patient had teratoma recurrence, and another patient had symptom fluctuation, and was discharged after condition was improved by symptomatic treatment during readmission. Conclu-sion Clinical manifestation of anti-NMDAR encephalitis is nonspecific, so it is easily misdiagnosed. Timely relevant antibody detection, performing tumor resection immediately and early immunosuppressant treatment for patients with tumors are impor-tant to avoid misdiagnosis and mistreatment.

关 键 词：抗N-甲基-D-门冬氨酸受体脑炎 畸胎瘤 糖皮质激素 免疫抑制剂 误诊 脑炎 精神障碍 

分 类 号：R742.9[医药卫生—神经病学与精神病学]