抗NMDA受体脑炎6例及文献复习  

A report of 6 cases with anti-N-methyl-D-aspartate receptor encephalitis and literature review

作　　者：赵超[1] 张卓[1] 段凤菊[1] 严琪[1] 周琼[1] 白苗 苗建亭[1] 李柱一[1] 

机构地区：[1]第四军医大学附属唐都医院神经内科,陕西西安710038

出　　处：《中国医药导报》2017年第2期175-178,共4页China Medical Herald

摘　　要：本文主要探讨抗N-甲基-D-天冬氨酸(NMDA)受体脑炎患者临床表现、磁共振、脑脊液特点、治疗及预后,以提高对该病的认识。本文回顾性分析6例抗NMDA受体脑炎患者的相关临床资料,并复习相关文献。6例患者中,男3例,女3例,年龄15~61岁,所有患者血清及脑脊液抗NMDA受体抗体为阳性,1例患者脑脊液抗NMDA受体抗体及抗GABA受体抗体均为阳性;3例患者以癫痫发作为首发症状,3例以精神行为异常为首发症状;5例患者伴有不自主运动症状;头颅MRI:1例双侧丘脑DWI高信号;1例左侧颞叶T2、FLAIR高信号;其余4例正常;脑脊液化验结果与病毒性脑炎脑脊液特点相似;2例女性患者伴有畸胎瘤,1例患者伴有小细胞肺癌,经过免疫药物治疗后,症状均有不同程度恢复。抗NMDA受体脑炎以精神异常、癫痫发作为首发症状多见,抗NMDA受体脑炎患者可合并有抗GABA受体抗体阳性;部分患者核磁共振及脑脊液化验结果缺乏特异性。伴有肿瘤的患者,肿瘤切除及应用一线免疫抑制剂治疗,可显著改善预后。To improve the recognition of anti-N-methyl-D-aspartate （NMDA） receptor encephalitis, this paper ana- lyzes the clinical presentation, magnetic resonance imaging （MRI）, cerebrospinal fluid （CSF）, treatment and prognosis. This paper analyzes the clinical data of 6 cases with anti-NMDA receptor encephalitis and reviews relevant literatures. Among 6 patients, 3 cases were male, 3 cases were female. The range of age was 15-61 years old. CSF and serum an- ti-NMDA receptor antibodies were positive in all patients. Anti-NMDA receptor antibodies and anti-GABA receptor antibodies were both positive in one patient. The epileptic attack as first symptom was observed in 3 patients. The mental and behavior disorder as first symptom was observed in 3 patients. 5 patients showed abnormal movements. The cranial MRI showed that DWI high signal intensity in bilateral thalamic regions in one patient. In another patient, the MRI showed T2/FLAIR high signal intensity in left temporal region, anti-NMDAR encephalitis of the left 4 patients showed no changes in the MRI. The CSF findings were in most respects similar to viral encephalitis： 2 cases had ter- atoma, one case had small cell lung carcinoma, and the symptoms were recovered inordinately after treatment of im- munoagents. The first symptom of anti-NMDAR encephalitis was often psychiatric or seizures. Anti-NMDA receptor encephalitis patients could be combined with anti-GABA receptor antibody. The CSF and MRI findings in some pa- tients were not specific. Patients associated with ovarian tumors underwent tumor excision and immunotherapy had re- markable efficacy.

关 键 词：抗N-甲基-天门冬氨酸受体脑炎 临床表现 核磁共振 脑脊液 治疗 

分 类 号：R651.2[医药卫生—外科学]