抗N-甲基-D-天冬氨酸受体脑炎前驱期与前驱事件  

Analysis of prodromal phase and prodromal events in anti-N-methyl-D-aspartate receptorencephalitis

作　　者：姚远 彭斌[1] 王晓慧[2] 方方[2] 徐丹[1] 徐晓璐[1] 任海涛[1] 朱以诚[1] 崔丽英[1] 关鸿志[1] 

机构地区：[1]中国医学科学院北京协和医院神经内科,100730 [2]首都医科大学附属北京儿童医院神经科

出　　处：《中华医学杂志》2017年第19期1469-1473,共5页National Medical Journal of China

基　　金：国家重点研发计划（2016YFC0901501）

摘　　要：目的分析抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎前驱期及前驱事件。方法收集2010—2016年间，在北京协和医院及北京儿童医院确诊并接受治疗的179例成人及儿童抗NMDAR脑炎患者的临床资料，筛选其中有前驱期或前驱事件的患者，回顾性分析其前驱期或前驱事件症状、病程特点、影像学及实验室检查结果、治疗反应。结果31.8%（57/179）的患者有前驱期，发热（73.7%）、头痛（68.4%）为最常见症状。其中6例患者（10.5%）前驱期延长，最长64 d，其中3例表现为脑膜炎样病程，症状仅有头痛、发热。6.1%（11/179）的患者有前驱事件，其中5例为单疱病毒脑炎，1例为乙型脑炎，2例为黑痣切除。结论抗NMDAR脑炎前驱期可延长，也可仅有前驱期症状而缺乏典型病程，可能均与感染有关。可能的前驱事件以病毒性脑炎为主，包括单疱病毒脑炎和乙型脑炎。Objective To analyze prodromal phase and prodromal events of anti-N-methyl-D- aspartate receptor （NMDAR） encephalitis. Methods Clinical data of 179 patients hospitalized and diagnosed during 2010-2016 including adults and children in Peking Union Medical College Hospital and Beijing Children＇s Hospital were collected. Patients with prodromal phase or prodromal events were selected. A retrospective analysis of clinical characteristics including prodromal phase or prodromal events, course of disease, brain imaging, laboratory results and therapeutic effect was performed. Results Prodromal phase was presented in 31.8% （57/179） of patients. Most common symptoms included fever （73.7%） and headache （68. 4% ）. Prodromal phase was prolonged in 6 patients, the longest being 64 days. Among those 6 patients （ 10. 5% ）, headache and fever were the only symptoms throughout disease courses in 3 cases. Prodromal events were reported in 6. 1% （11/179） of patients, including 5 patients after HSV1 encephalitis, 1 after Japanese encephalitis, and 2 after resection of melanocytic nevi. Conclusions Anti- NMDAR encephalitis can be preceded with prolonged prodromal phase. In some patients prodromal symptoms are the only clinical presentation. Clinical features of those atypical cases suggest that infection may be the precipitating factor. Viral encephalitis including HSV1 encephalitis and Japanese encephalitis may be prodromal events in some cases.

关 键 词：抗N-基-D-冬氨酸受体脑炎 前驱症状 

分 类 号：R742.9[医药卫生—神经病学与精神病学]