利妥昔单抗治疗儿童抗NMADR脑炎疗效分析  

Retrospective Study of Rituximab in the Treatment Anti-N-methyl-D-aspartate Receptor Encephalitis in Children

作　　者：于春梅[1] 屈晓[1] 张洪伟[1] 刘勇[1] YU Chunmei;QU Xiao;ZHANG Hongwei;LIU Yong(Department of Pediatric Neurology,Jinan Children's Hospital,Ji’nan Shandong 250022,China)

机构地区：[1]济南市儿童医院神经内科

出　　处：《中国继续医学教育》2019年第33期128-130,共3页China Continuing Medical Education

基　　金：济南市卫生和计划生育委员会科技计划项目(2016-1-51)

摘　　要：目的分析利妥昔单抗治疗儿童抗NMADR脑炎,观察病情恢复情况,监测药物副作用,探究其治疗效果。方法回顾性研究32例抗NMADR脑炎患儿,进行临床资料收集并随访,所有病例均给予免疫球蛋白及甲泼尼龙治疗,其中12例病情较危重加用利妥昔单抗治疗。根据是否应用利妥昔单抗将所有患儿分为治疗组及对照组。观察临床症状恢复情况,并使用改良Ranking量表(mRS)评估患儿神经功能恢复情况。结果两组患儿治疗前发病高峰mRS评分:对照组(3.26±0.87)分,治疗组(4.33±0.78)分,差异有统计学意义(P<0.05)。治疗组应用利妥昔单抗1月后mRS评分(1.25±0.45)分,随访3月时mRS评分(1.52±0.55)分,随访半年mRS评分(0.92±0.51)分,两组差异有统计学意义(P<0.05)。随访1年,对照组的患儿有5例复发,治疗组无复发病例。显示利妥昔单抗组治疗效果更好,临床症状渐缓解,脑电图基本恢复。在治疗过程中未出现严重不良反应。结论利妥昔单抗治疗儿童重症抗NMADR脑炎能够使症状基本缓解,是抗NMADR脑炎患儿的有效治疗手段之一。病情高峰期mRS评分较高及应用一线免疫治疗效果差的患儿应及早加利妥昔单抗治疗,降低复发率。Objective To analyze treatments to rituximab of children against NMAD encephalitis,observe recoveries of nerve functions,monitor its side effects and explore its therapeutic effects.Methods A retrospective study was conducted on 32 children with anti-NMADR encephalitis.Clinical data were collected and followed up.All patients were treated with immunoglobulin and methylprednisolone,12 of whom were more critical and treated with rituximab.The children were divided into treatment group and control group according to whether rituximab was used or not.The recovery of clinical symptoms was observed and the neurological function was assessed by modified Ranking scale(mRS).Results The peak mRS score of the two groups before treatment was(3.26±0.87)in the control group and(4.33±0.78)in the treatment group,with significant difference(P<0.05).The treatment group received rituximab 4 weeks later,the mRS score was(1.25±0.45),the mRS score was(1.52±0.55)at 3 months followup,and the mRS score was(0.92±0.51)at 6 months follow-up.There was significant difference between the two groups(P<0.05).Following up for 1 year,there were 5 cases of recurrence in the control group,and no recurrence in the treatment group.It is suggested that rituximab group has better therapeutic effect,clinical symptoms are gradually relieved and EEG is basically restored.No serious adverse reactions occurred during the treatment. Conclusion Rituximab can relieve the symptoms of severechildren with NMADR encephalitis, and it is one of the effective treatmentmethods for children with NMADR encephalitis. Children with high mRSscore at the peak of illness and poor first-line therapy should be treatedwith rituximab as early as possible to achieve better results and reducerecurrence.

关 键 词：利妥昔单抗 抗-NMDAR脑炎 抗体 治疗效果 复发 儿童 

分 类 号：R742[医药卫生—神经病学与精神病学]