卵巢肿瘤合并抗NMDAR脑炎——附110例病例分析  

Ovarian tumor associated with anti-N-methyl-D-aspartate receptor encephalitis: A report of 110 cases

作　　者：蒋慧云[1] 李小毛[1] 叶辉霞[1] 郑泽纯[1] 王佳[1] 高慧娟[1] 黄珊瑜[1] Jiang Huiyun;Li Xiaomao;Ye Huixia;Zheng Zechun;Wang Jia;Gao Huijuan;Huang Shanyu(Department of Gynecology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China)

机构地区：[1]中山大学附属第三医院妇科,广州510630

出　　处：《中国医师杂志》2019年第2期172-175,共4页Journal of Chinese Physician

摘　　要：目的总结卵巢肿瘤合并抗N-甲基-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。方法收集2009年1月至2018年12月间本院收治的、以及国内病例报告中的卵巢肿瘤合并抗NMDAR脑炎患者的临床资料,对其临床特征、治疗及预后进行分析。结果共收集到110例卵巢肿瘤合并抗NMDAR脑炎患者,所有患者均血清和(或)脑脊液抗NMDAR抗体阳性。发病年龄10～35(24. 6±5. 7)岁; 60. 9%患者以精神行为异常为首发症状,主要临床症状可分为精神行为异常(97. 3%)、癫痫(83. 6%)、意识障碍(72. 7%)、自主神经功能障碍(64. 5%)、运动障碍(64. 5%)、中枢性低通气综合征(54. 5%)、记忆力障碍(31. 8%)。经过免疫治疗及手术治疗,大多数患者症状明显好转。术后病理示97. 8%为卵巢畸胎瘤。手术组患者预后好于未手术组,差异有统计学意义(P <0. 05);患侧附件切除术组患者预后好于卵巢肿瘤剔除术组,差异有统计学意义(P <0. 05)。结论卵巢肿瘤相关抗NMDAR脑炎发病以精神-神经症状为主,对于出现精神行为异常的年轻女性,临床医师应警惕抗NMDAR脑炎可能性,同时须积极对其进行肿瘤筛查;患侧附件切除术联合免疫治疗预后更佳。Objective To summarize the clinical features of patients with ovarian tumor associated anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, and to explore the influence of operation patterns on the prognosis. Methods The clinical data of ovarian tumors with anti-NMDAR encephalitis in the Third Affiliated Hospital of Sun Yat-sen University from January 2009 to December 2018 were collected, and the clinical characteristics, treatment and prognosis were analyzed. Results A total of 110 patients with ovarian tumors and anti-NMDAR encephalitis were collected. All patients were positive for anti-NMDAR antibodies in serum and/or cerebrospinal fluid. The age of onset ranged from 10 to 35 years (24.6±5.7). About 60.9% patients' initial symptom was psychosis. The main clinical features were psychosis (97.3%), seizures (83.6%), conscious disturbance (72.7%), autonomic dysfunction (64.5%), dyskinesia (64.5%), central hypoventilation (54.5%) and impaired memory (31.8%). Most patients' symptoms were relieved after surgery and immunotherapy. Postoperative pathological results revealed that ovarian teratoma accounted for 97.8% of the ovarian tumor. The prognosis of patients with surgery was better than the patients without surgery, with statistically significant difference (P<0.05). The prognosis of patients with adnexectomy was better than the patients with ovarian tumor excision , with statistically significant difference (P<0.05). Conclusions Anti-NMDAR encephalitis, with psycho-neurological symptoms as dominant manifestation, is usually associated with ovarian tumor. For young female patients with psychosis, clinicians should be alert to the possibility of anti-NMDAR encephalitis and screen for tumor. Patients with adnexectomy and immunotherapy can get a better prognosis.

关 键 词：卵巢肿瘤 抗N-甲基-D-天冬氨酸受体脑炎 预后 

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