卵巢肿瘤合并抗N-甲基-D-天冬氨酸受体脑炎15例临床分析  

Ovarian tumor associated with anti-N-methyl-D-aspartate receptor encephalitis： a report of 15 cases

作　　者：李小毛[1] 蒋慧云[1] 王沂峰[3] 邱伟[2] 王颖[3] 吴昊天[2] 

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 [3]南方医科大学珠江医院妇产科

出　　处：《中华医学杂志》2017年第37期2932-2935,共4页National Medical Journal of China

摘　　要：目的总结卵巢肿瘤合并抗N一甲基一D．天冬氨酸受体（NMDAR）脑炎患者的临床特征，并比较不同手术方式对预后的影响。方法回顾性分析2009年1月至2016年6月间在中山大学附属第三医院及南方医科大学珠江医院就诊的卵巢肿瘤合并抗NMDAR脑炎患者临床资料及预后。结果共纳入卵巢肿瘤合并抗NMDAR脑炎患者15例，年龄平均（24．5±5．0）岁。9例患者以精神行为异常为首发症状，主要临床症状包括精神行为异常、癫痫、意识障碍、自主神经功能障碍、运动障碍、中枢性低通气综合征、记忆力障碍。在免疫治疗的基础上，结合手术治疗，大多数患者可获得良好预后。患侧附件切除组预后较好的患者（mRS评分0-2分）多于肿瘤剔除组（5比3），但两者间的差异无统计学意义（P=0．529）。结论对于出现精神异常的年轻女性，应警惕抗NMDAR脑炎可能性，并积极进行肿瘤筛查。予免疫治疗结合手术治疗，大多数患者能获得良好预后。Objective To summarize the clinical features of patients with ovarian tumor and anti-N- methyl-D-aspartate receptor（NMDAR） encephalitis, and to explore the influence of operation patterns on the prognosis. Methods The clinical information of patients with ovarian tumor and anti-NMDAR encephalitis in The 3rd Affiliated Hospital of Sun Yat-Sen University and The Zhujiang Hospital of Southern Medical University were collected and analyzed. Results There were 15 patients were enrolled in this study, with the average age of 24. 5 -＋ 5.0 years old. The most frequent first symptom was psychosis. The main clinical features were psychosis, seizures, conscious disturbance, autonomic dysfunction, dyskinesia, central hypoventilation and impaired memory. Most patients＇ symptoms were relieved after immunotherapy and surgery. The number of favorable prognosis of patients （ mRS score 0 - 2 ） with ovariectomy was higher than that of the patients with ovarian eystectomy （ 5 vs 3 ）. But the difference had no statistical significance （ P = 0. 529）. Conclusions For young female patients with psychosis, we should be alert to the possibility of anti-NMDAR encephalitis and screen for tumor. Treated with immunotherapy and operation, most patients can get a favorable prognosis.

关 键 词：肿瘤 脑炎 受体 N-甲基-D-天冬氨酸 预后 

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