伴或不伴头颅磁共振异常的抗N-甲基-D-天冬氨酸受体脑炎患儿的对比研究  

A comparative analysis of anti-N-methyl-D-aspartate receptor encephalitis with or without abnormal findings on cranial magnetic resonance imaging

作　　者：张建昭[1] 陈倩[1] 郑萍[1] 谢丽娜[1] 仪晓立[1] 任海涛[2] 杨健[1] 

机构地区：[1]首都儿科研究所附属儿童医院神经内科,北京100020 [2]中国医学科学院北京协和医院神经内科,北京100730

出　　处：《中国当代儿科杂志》2018年第1期48-51,共4页Chinese Journal of Contemporary Pediatrics

摘　　要：目的对头颅MRI异常或正常的抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患儿进行对比研究。方法回顾性分析33例抗NMDAR脑炎患儿的临床特点,并比较头颅MRI异常或正常患儿之间的临床特点及预后差异。结果 33例患儿发生率前5位的首发症状依次为癫癎发作(61%)、不自主运动(61%)、语言障碍(54%)、精神行为异常(52%)和意识障碍(30%)。所有患儿的脑脊液抗NMDAR抗体均阳性,29例(88%)血清抗体阳性。脑脊液白细胞升高的15例(46%),3例(9%)蛋白升高,寡克隆阳性29例(88%)。脑电图异常(癫癎波或慢波或合并存在)患儿26例(79%)。仅1例发生呼吸衰竭。1例在随诊过程中发现蝶鞍区生殖细胞瘤。33例患儿中头颅MRI异常的13例(39%):T1WI表现为低信号或等信号、T2WI及T2-FLAIR表现为高信号,病变部位包括颞叶(38%)、额叶(23%)、基底节(23%)、顶叶(15%)、枕叶(15%)、脑干(15%)、丘脑和小脑(各8%),其中以灰质病变为主者5例(38%)、白质病变为主者8例(62%),2例患儿存在脑膜强化。头颅MRI异常患儿的前驱感染比例、意识障碍发生率、病情反复的几率、Glasgow严重评分、脑脊液白细胞升高发生率、二线治疗的应用率均高于头颅MRI正常的患儿,差异具有统计学意义(P<0.05)。结论头颅MRI异常的抗NMDAR脑炎患儿具有某些临床特点,这些特点对于病情的判断和诊疗措施的选择具有一定的指导意义。Objective To investigate the clinical features of children with anti-N-methyl-D-aspartate receptor（anti-NMDAR） encephalitis with normal or abnormal cranial magnetic resonance imaging（MRI） findings via a comparative analysis. Methods A retrospective analysis was performed for the clinical data of 33 children with anti-NMDAR encephalitis. The clinical features and prognosis were compared between the children with normal and abnormal cranial MRI findings. Results In the 33 children with anti-NMDAR encephalitis, the most common initial symptoms were seizures（61%） and involuntary movement（61%）, followed by language disorder（54%）, mental and behavioral abnormalities（52%）, and disturbance of consciousness（30%）. All children had positive anti-NMDAR antibody in the cerebrospinal fluid, and 29 children（88%） had positive serum antibody. Of all the children, 15（46%） had increased leukocytes in the cerebrospinal fluid, 3（9%） had an increase in protein, and 29（88%） had positive oligoclonal band; 26 children（79%） had electroencephalographic abnormalities（epileptic wave, slow wave, or a combination of these two types of waves）. One child experienced respiratory failure. One child was found to have germinoma in the sellar region during follow-up. Of all the 33 children, 13（39%） had abnormal cranial MRI findings, with hypointensity or isointensity on T1 W1 and hyperintensity on T2 WI and T2-FLAIR; 2 children had dural enhancement. As for the location of lesion, 5 children（38%） had lesions in the temporal lobe, 3（23%） in the frontal lobe, 3（23%） in the basalganglia, 2（15%） in the parietal lobe, 2（15%） in the occipital lobe, 2（15%） in the brainstem, 1（8%） in the thalamus, and 1（8%） in the cerebellum. Among the 13 children with abnormal cranial MRI findings, 5（38%） had lesions mainly in the grey matter and 8（62%） had lesions mainly in the white matter. Compared with the children with normal cranial MRI findings, the children with abnormal

关 键 词：头颅磁共振 N-甲基-D-天冬氨酸受体 脑炎 儿童 

分 类 号：R742.9[医药卫生—神经病学与精神病学]