卵巢畸胎瘤合并抗N-甲基-D-天冬氨酸受体脑炎9例临床分析  

Clinical analysis of ovarian teratoma complicated with anti-N-methyl-D-aspartate receptor encephalitis:a report of 9 cases

作　　者：李小毛[1] 蒋慧云[1] 陆正齐[2] 杨越波[1] 李田[1] 王佳[1] 

机构地区：[1]中山大学附属第三医院妇科,广州510630 [2]中山大学附属第三医院神经内科,广州510630

出　　处：《新医学》2017年第2期118-123,共6页Journal of New Medicine

摘　　要：目的总结卵巢畸胎瘤合并抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患者的临床特征,探讨畸胎瘤与抗NMDAR脑炎之间的关系。方法收集9例卵巢畸胎瘤合并抗NMDAR脑炎患者的临床资料,对其临床特征、辅助检查、治疗及预后进行总结分析。结果 9例卵巢畸胎瘤合并抗NMDAR脑炎女性患者,中位年龄为25岁,5例患者有上呼吸道感染等前驱症状,主要临床表现为精神行为异常、癫痫、运动障碍、自主神经功能障碍、意识障碍和中枢性低通气;脑脊液抗NMDAR抗体均为阳性。其中6例患者行患侧附件切除术,2例行畸胎瘤剔除术,症状均明显好转。出院后随访至今均未出现症状复发。结论对于急性起病,出现明显精神症状、癫痫发作的年轻女性患者,应高度警惕抗NMDAR脑炎的可能性,并积极通过影像学手段筛查肿瘤;通过肿瘤切除及免疫治疗,大多数抗NMDAR脑炎患者可获得良好预后。Objective To summarize the clinical characteristics of ovarian teratoma patients complicated with anti-N-methyl-D-aspartate receptor（ NMDAR） encephalitis,aiming to investigate the relationship between teratoma and anti-NMDAR encephalitis. Methods Clinical data of 9 patients with ovarian teratoma complicated with anti-NMDAR encephalitis were collected. Clinical characteristics,auxiliary examination,clinical treatment and prognosis were analyzed. Results Nine female ovarian teratoma patients complicated with anti-NMDAR encephalitis were enrolled in this clinical trial,with median aged 25 years old. Over half of the patients（ 55. 5%） had prodromes including upper respiratory tract infection. The main clinical characteristics included psychosis,seizures,dyskinesia,autonomic dysfunction,conscious disturbance and central hypoventilation. Cerebrospinal fluids were all positive for anti-NMDAR antibodies. Six patients underwent ovariectomy,and two received teratoma resection. All patients＇ symptoms were significantly relieved. No recurrence was observed during subsequent follow-up. Conclusions The possibility of anti-NMDAR encephalitis should be considered and imaging screening of tumors should be delivered for young females presenting with acute psychosis and seizure. Most anti-NMDAR encephalitis patients can obtain favorable prognosis after tumor resection and immunotherapy.

关 键 词：畸胎瘤 N-甲基-D-天冬氨酸受体 脑炎 

分 类 号：R737.31[医药卫生—肿瘤] R742.9[医药卫生—临床医学]