自身免疫性脑炎患儿的临床鉴别诊断以及治疗分析  

Clinical differential diagnosis and treatment analysis of children with autoimmune encephalitis

作　　者：方红军[1] 胡文静[1] 冯枚[1] 王平[1] 廖红梅[1] 

机构地区：[1]湖南省儿童医院神经二科,湖南长沙410007

出　　处：《实用检验医师杂志》2017年第3期180-182,共3页Chinese Journal of Clinical Pathologist

摘　　要：目的探讨自身免疫性脑炎(AE)患儿的临床鉴别诊断以及治疗。方法选择湖南省儿童医院儿科2011年至2016年4月收治的50例AE患儿作为研究对象,采用回顾性分析法对其临床鉴别诊断及治疗进行分析。结果 50例患者中抗电压-门控钾通道(VGKC)脑炎10例,抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎8例,边缘叶脑炎32例;3组在临床特征、核磁共振(MR)检查、脑脊液检测、免疫肿瘤治疗效果指标检测等方面均存在差异性,可以用这些指标进行AE的临床鉴别诊断。分析入选患儿的治疗和预后结果显示,其中预后良好13例,复发8例,继发癫痫16例,有认知障碍9例,有精神障碍4例。结论 AE的分类较广,其发病原因较广,需要辅助临床特征、MR检查、脑脊液检测、免疫肿瘤治疗效果指标检测等方法对其进行临床鉴别诊断,进而实施针对性的治疗,以提高AE的治疗效果。Objective To investigate the clinical differential diagnosis and treatment of autoimmune encephalitis （AE）. Methods Fifty patients with AE were enrolled in the pediatric department of Hunan Children＇s Hospital from April 2011 to April 2016. The clinical diagnosis and treatment were analyzed retrospectively. Results There were 10 cases of anti-voltage-gated potassium channel （VGKC） encephalitis in 50 patients, 8 cases of N-methyl-D-aspartate receptor （NMDAR） encephalitis and 32 cases of marginal encephalitis. There were differences in clinical features, nuclear magnetic resonance （MR）, eerebrospinal fluid test, and immunosuppressive therapy, which can be used to diagnose AE. Analysis of treatment and prognosis of selected children showed a good prognosis in 13 cases, 8 cases of recurrence, secondary epilepsy in 16 cases, 9 cases of cognitive impairment, mental disorders in 4 cases. Conclusions The classification of AE is wide and its pathogenesis is more extensive. It needs to be diagnosed by clinical features such as clinical features, MR examination, cerebrospinal fluid test and immunosuppressive therapy, and then to carry out targeted treatment to improve AE treatment effect.

关 键 词：自身免疫性脑炎 鉴别诊断 针对性治疗 

分 类 号：R446.6[医药卫生—诊断学] R742.9[医药卫生—临床医学]