感染相关的抗N-甲基-D-天冬氨酸受体脑炎的临床特点分析  

Clinical characteristics of anti-N-methyl-D-aspartate receptor encephalitis after infection

作　　者：朱纪玲 黄梁江[1] 郑彩凤 宋建新[1] 张苏明[1] 邢铭友[1] ZHU Ji-ling;HUANG Liang-jiang;ZHENG Cai-feng;SONG Jian-xin;ZHANG Su-ming;XING Ming-you(Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Chin)

机构地区：[1]华中科技大学同济医学院附属同济医院,武汉430030

出　　处：《内科急危重症杂志》2018年第1期8-11,共4页Journal of Critical Care In Internal Medicine

基　　金：国家自然科学基金资助项目(No:81771272)

摘　　要：目的:总结感染后出现的抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的临床特点。方法:收集5例感染后出现的抗NMDAR脑炎患者临床病历资料,并检索感染性因素相关的NMDAR脑炎的文献资料,分析此类疾病的临床特点。结果:5例(男4,女1)呼吸道感染后出现的抗NMDAR脑炎患者,平均年龄23.4岁,所有患者均未发现肿瘤,3例合并其他自身免疫性抗体。感染至发病的时间(5.2±2.8)d。主要症状包括发热、精神行为异常、癫痫发作、小便障碍,平均确诊时间达(40.6±25.4)d。血清和脑脊液的NMDAR抗体滴度均达到()。脑脊液检查以轻度细胞数升高和/或蛋白升高为主,有4例出现头颅磁共振及脑电图检查异常,2例进重症监护病房。经过免疫治疗后,有3例预后良好,2例预后一般。5例患者病程中均出现反复发作,2年内总复发次数达11次。结论:感染因素可以诱发抗NMDA抗体脑炎,其多在感染后1周内发病。主要症状仍以发热、精神行为异常为主,容易误诊为病毒性脑炎,脑脊液NMDAR抗体检测有助于明确诊断,免疫治疗后复发率高、预后欠佳。Objective： To summarize the clinical characteristics of anti-NMDA receptor（ anti-NMDAR） encephalitis induced by infection. Methods： The clinical data and treatment process of 5 cases of anti-NMDAR encephalitis induced by infection were collected and analyzed retrospectively. The literatures about infection-related NMDAR encephalitis were reviewed. The clinical characteristics of NMDAR encephalitis induced by infection were analyzed. Results： Five cases（4 males and one female） of NMDAR encephalitis after pulmonary infection were treated,with an average age of 23. 4 years.Tumors were not found in all patients after screening,and the duration from the infection to onset was（5.2 ± 2.8） days.Main symptoms included fever,psychiatric disorder,seizures,urinate disturbance. The average diagnosis time was（40.6 ±25.4） days. The titer of NMDAR antibody in serum and cerebrospinal fluid reached（ ）. Cerebrospinal fluid examination revealed mild increases in cells and（ or） proteins. Four cases had abnormal head MRI scanning and EEG examination. Two cases were treated in ICU. Three patients had good recovery,while rest two patients recovered poorly after immunotherapy.Five cases had repeated onset druing the disease duration,and total number of relapse was 11 times within 2 years. Conclusion： Infection could induce anti-NMDA receptor encephalitis,mostly within 1 week after infection. The main clinical manifestations were fever and psychiatric disorder,while the symptoms were serious and early diagnosis was difficult. It is easy to misdiagnose as viral encephalitis. The antibody examination in cerebrospinal fluid is vital to diagnosis. The prognosis is relatively poor and there is high recurrence rate after the immune treatment.

关 键 词：脑炎 抗N-甲基-D-天冬氨酸受体 呼吸道感染 免疫治疗 临床特点 

分 类 号：R512.3[医药卫生—内科学]