自身免疫性脑炎的临床分析及脑电图特点  

Autoimmune encephalitis 9 cases of clinical feature analysis and electroencephalogram characteristics

作　　者：黄明珠[1] 陈丽真 陈圣根[1] 车春晖[1] 黄华品[1] 

机构地区：[1]福建医科大学附属协和医院神经内科,福建福州350000

出　　处：《中国实用神经疾病杂志》2018年第3期273-278,共6页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然基金面上项目(81371426)

摘　　要：目的探讨自身免疫性脑炎的临床表现、脑电图、影像、脑脊液特点及治疗转归。方法回顾性分析福建医科大学附属协和医院神经内科2015—2017年自身免疫性脑炎患者9例。结果 9例患者平均发病年龄44.3岁,抗LGIl抗体阳性1例,抗GABA阳性2例,NMDA受体抗体阳性4例,抗Yo抗体阳性1例,抗PNMA2(Ma2/Ta)抗体阳性1例;3例检出肿瘤。以精神行为异常为首发症状3例,以癫痫发作为首发症状4例,所有病例中出现癫痫发作8例(88.9%),出现精神异常6例(66.7%),出现不自主运动3例(33.3%),出现认知下降7例(77.7%)。MRI检查无特异性表现7例(77.7%),2例异常。脑脊液压力、细胞、蛋白正常5例,异常4例(44.44%);脑电图异常9例(100%),其中2例(22.2%)存在σ刷。8例行丙种球蛋白冲击,1例回当地医院治疗,66.7%的患者预后良好。结论功能损害、精神行为异常、癫痫发作为主要表现的患者,要警惕自身免疫性脑炎的可能,以免误漏诊,脑电图尤其视频脑电图在早期诊断上具有重要意义,并可作为追踪随访评估疗效其中脑电图是一个重要评估方式。Objective To explore the characteristics of clinical manifestation, magnetic resonance imaging （MRI）, cerebro- spinal fluid（CSF） and treatment outcome of autoimmune encephalitis（AE）. Methods The clinical data of 9 patients with retro- spectively analyzed. Results Among these patients, 4 of them were proved to have anti-N-methyl-D-aspartate receptor（NMDA） encephalitis,while 1 of them got diagnosis of anti-leucine-rich glioma-inactivated protian 1 antibody（LG1） encephalitis, and the other 2 had anti-y-aminobutyric acid 13 receptor（GABAR） antibody. 88.9% of the patients had seizure, 66.7% of the patients had involuntary movement and autonomic nerve dysfunction. 44.4% of the patients had abnormal CSF, while 100% of them showed abnormal in EEG, 22.2% patients had abnormal MRI signal. 8 patients accepted immunoglobulin therapy, and 1 paitents returned to local hospital for treatment, 66.7% of them had favorable prognosis. Conclusion Electroencephalogram is an important method to evaluate autoimmune encephalitis.

关 键 词：自身免疫性脑炎 癫痫 σ刷 NMDAR脑炎 GABAR脑炎 

分 类 号：R742.1[医药卫生—神经病学与精神病学]