抗γ-氨基丁酸B型受体脑炎的临床特征  

Clinical characteristics of anti-gamma aminobutyric acid B receptor encephalitis

作　　者：卢凯 朱遂强[1] LU Kai;ZHU Sui-qiang(Department of Neurology,Tongji Hospital Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430030

出　　处：《临床神经病学杂志》2022年第1期40-44,共5页Journal of Clinical Neurology

基　　金：湖北省技术创新专项(2019ACA132)。

摘　　要：目的分析抗GABA B型受体(GABA;R)脑炎的临床特征,血清和CSF抗体敏感度、滴度变化以及癫痫的治疗。方法回顾性分析13例抗GABA;R脑炎患者的临床资料。结果本组男性8例(61.5%),女性5例(38.5%);中位年龄52岁(41~61岁)。10例(76.9%)首发症状为癫痫。所有患者均出现痫性发作,10例(76.9%)记忆力下降,10例(76.9%)精神行为异常,3例(23.1%)合并肺癌。血清和CSF抗GABA;R抗体敏感度为90.9%。6例患者行免疫治疗后复查抗GABA;R抗体,4例症状好转后抗体滴度明显下降,2例症状加重后抗体滴度升高。经过免疫治疗和抗癫痫药物治疗,6个月后,72.7%的患者癫痫无发作,36.4%的患者需抗癫痫药物治疗;24个月时,100%的患者癫痫无发作,仅10%的患者仍需抗癫痫药物治疗。结论抗GABA;R脑炎多见于中老年男性,常合并肿瘤,主要表现为癫痫发作、记忆力下降、精神行为异常等。为了避免漏诊,建议同时送检血清和CSF检测抗体。大多数抗GABA;R脑炎患者不需要长期使用抗癫痫药物。Objective To assess the clinical characteristics,sensitivity and titers of serum and CSF antibody-testing,seizure treatment in anti-GABA B receptor(GABA;R)encephalitis.Methods The clinical data of 13 anti-GABA;R encephalitis patients were retrospectively analyzed.Results There were 8 males(61.5%)and 5 females(38.5%)in this group;the median age was 52 years(41-61 years).The first symptom of 10 cases(76.9%)was epilepsy.All patients had seizures,10 cases(76.9%)had cognitive dysfunction,10 cases(76.9%)had abnormal mental behavior,and 3 cases(23.1%)had lung cancer.The sensitivity of serum and CSF anti-GABA;R antibodies was 90.9%.Anti-GABA;R antibody was re-examined in 6 patients after immunotherapy.The antibody titer decreased significantly in 4 patients after symptom improvement and increased in 2 patients after symptom aggravation.After immunotherapy and antiepileptic drugs,72.7%of the patients had no seizures and 36.4%needed antiepileptic drugs at 6 months;after 24 months,100%of patients had no seizures,and only 10%of patients still needed antiepileptic drugs.Conclusions Anti-GABA;R encephalitis is common in middle-aged and elderly men,which is often associated with tumors,mainly manifested as seizures,cognitive dysfunction,and abnormal behaviors.To avoid the missed diagnosis,it is recommended to simultaneously detect serum and CSF antibodies.Most patients with GABA;R encephalitis do not need long-term use of antiepileptic drugs.

关 键 词：癫痫 抗体滴度 自身免疫性脑炎 抗γ-氨基丁酸B受体脑炎 

分 类 号：R512.3[医药卫生—内科学]