抗γ氨基丁酸B型受体脑炎八例临床分析  

Patients with anti-GABA B receptor encephalitis: 8 cases report

作　　者：张静[1] 李杰[1] 庞炳昕 温小敏 郭力[1] Zhang Jing;Li Jie;Pang Bingxin;Wen Xiaomin;Guo Li(Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000,China;Department of Radiology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000 [2]河北医科大学第二医院影像科,石家庄050000

出　　处：《中华医学杂志》2019年第25期1985-1988,共4页National Medical Journal of China

摘　　要：目的探讨抗γ氨基丁酸B型(GABA B)受体脑炎患者的临床特点、治疗和预后。方法对2016年4月至2018年2月就诊于河北医科大学第二医院神经内科的抗GABA B受体脑炎患者的临床资料进行回顾性分析。结果8例抗GABA B受体脑炎患者均出现癫痫发作;首发症状为癫痫发作者6例,记忆力减退者1例,精神行为异常者1例;脑脊液压力增高4例,蛋白增高2例,淋巴细胞增高4例;8例患者均出现不同程度脑电图异常;4例患者头颅MRI显示边缘系统异常信号;所有患者血清及脑脊液抗GABA B受体抗体均为阳性;4例伴有小细胞肺癌;所有患者均给予免疫治疗,症状有不同程度改善。出院后6~24个月随访,完全恢复者1例,其余7例患者遗留轻微症状。结论抗GABA B受体脑炎多以癫痫发作为首发症状,以难治性癫痫为主要特点,约半数合并肿瘤,临床应同时积极行抗GABA B受体抗体检测及肿瘤筛查。Objective To discuss the clinical features, diagnosis, therapy and prognosis of anti-GABA B receptor encephalitis. Methods Clinical data of patients with anti-gaba B receptor encephalitis admitted to the department of neurology of the second hospital of hebei medical university from April 2016 to February 2018 were collected and retrospectively analyzed. Results Eight patients with anti-GABA B receptor encephalitis were included. All the eight cases presented with epileptic seizures. The initial symptoms were clinical seizures in six cases, memory deficit in one case, mental and behavior disorder in one case. Cerebrospinal fluid (CSF) test indicated high intracranial pressure in four patients, increased protein in two patients and lymphocytosis in four patients. Long-term electroencephalogram (EEG) showed abnormal in all patients. Brain MRI showed limbic system lesions in four patients. The anti-GABA B receptor antibody was positive in both serum and CSF in all patients. Four patients had small cell lung cancer. All the eight patients received immunotherapy and symptoms were improved. After 6-24 months' follow-up, 1 patient recovered completely, and in the remaining 7 patients, mild symptoms were left behind. Conclusions The anti-GABA B receptor encephalitis is characterized by refractory epilepsy. Epilepsy is the most common initial symptom. About 50% patients are accompanied by tumors. Anti-GABA B receptor antibodies testing and tumor screening should be actively carried out.

关 键 词：抗γ氨基丁酸B型受体脑炎 自身免疫性脑炎 癫痫 

分 类 号：R742.9[医药卫生—神经病学与精神病学]