抗GABA B型受体脑炎的临床特点分析  

The clinical characteristics analysis of anti-GABA B receptor encephalitis

作　　者：卢节平 肖芳 宋笑凯 丁小灵 LU Jie-ping;XIAO Fang;SONG Xiao-kai(Department of Neurology,First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)神经内科,合肥230001 [2]中国科学技术大学附属第一医院(安徽省立医院)影像中心,合肥230001

出　　处：《临床神经病学杂志》2021年第5期373-376,共4页Journal of Clinical Neurology

基　　金：中央高校基本科研业务费专项资金资助(WK9110000098)。

摘　　要：目的分析抗GABA B受体(GABABR)脑炎患者的临床特点。方法回顾性分析2016年4月至2020年1月中国科学技术大学附属第一医院神经内科收治的10例抗GABABR脑炎患者的临床资料,分析其临床症状、辅助检查、治疗方案和预后特点。结果 10例患者主要临床症状为癫痫、精神行为异常、认知障碍。最常见的首发症状及症状均为癫痫。5例头颅MRI异常,主要累及海马和颞叶。1例患者既往有口腔鳞状细胞癌,3例肺部CT发现占位,其中2例病理证实为小细胞肺癌(SCLC)。9例患者接受一线免疫治疗,短期内症状均不同程度好转。平均随访17.4个月,3例患者随访期内发现肺癌,1例因癫痫发作坠河溺亡,3例死于肺癌,5例病情稳定,预后良好。结论抗GABABR脑炎常见症状为癫痫、精神行为异常和认知障碍,最常见的首发症状及症状均为癫痫,常伴发SCLC。一线免疫治疗短期效果好。部分患者随访期发现肺癌,患者总体预后差,尤其是合并肺癌者。Objective To analyze the clinical features and prognosis of patients with anti GABA B receptor(GABA_(B)R) encephalitis. Methods The clinical data of 10 cases of anti GABA_(B)R encephalitis admitted to the Department of Neurology of First Affiliated Hospital of the University of Science and Technology of China from April 2016 to January 2020 were retrospectively analyzed. And the clinical symptoms, auxiliary examination, treatment and prognosis were analyzed. Results The main clinical manifestations of these 10 patients were seizures, abnormal mental behaviors and cognitive disorders, among which seizure was the most common and initial symptom. Brain MRI showed abnormal signals in 5 patients, mainly located in the hippocampus and temporal lobes. There was 1 patient with the previous oral squamous cell carcinoma. Lung masses were found by CT in 3 patients, 2 of which were confirmed small cell lung cancer(SCLC) by pathology. Nine patients received first-line immunotherapy and their symptoms were improved by different degrees in the short term. After an average follow-up of 17.4 months, lung cancers were found in 3 patients, 1 patient died of drowning due to seizure, 3 patients died of lung cancer, and 5 patients were in clinically stable condition with good prognosis. Conclusions The predominant clinical features of the anti GABA_(B)R encephalitis are seizures, abnormal mental behaviors and cognitive disorders, with seizure as the most common and initial symptom, and often associated with SCLC. The first-line immunotherapy shows a good short-term effect. Lung cancers are found in some patients during the follow-up period, and the overall prognosis of patients with anti GABA_(B)R encephalitis is poor, especially those with lung cancer.

关 键 词：抗GABA B受体脑炎 自身免疫性脑炎 癫痫 小细胞肺癌 

分 类 号：R742.9[医药卫生—神经病学与精神病学]