儿童单纯疱疹病毒脑炎合并抗NMDAR和抗Hu抗体双重阳性自身免疫性脑炎的临床特点(附1例报告)  

Clinical features of autoimmune encephalitis with double positive anti-NMDAR and anti-Hu antibodies in a child following herpes simplex encephalitis(report of one case)

作　　者：毛丹丹 胡文广 刘平 邓佳 李思秀 蓝明平 MAO Dandan;HU Wenguang;LIU Ping;DENG Jia;LI Sixiu;LAN Mingping(不详;Department of Pediatric Neurology,Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,China)

机构地区：[1]电子科技大学医学院附属妇女儿童医院,成都市妇女儿童中心医院神经内科,611731

出　　处：《中国神经免疫学和神经病学杂志》2022年第3期211-215,共5页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨儿童单纯疱疹病毒感染合并抗N-甲基-D-天冬氨酸受体(NMDAR)和抗Hu抗体双阳性自身免疫性脑炎(autoimmune encephalitis,AE)的临床特点。方法回顾分析作者医院神经内科收治的1例单纯疱疹病毒性脑炎合并抗NMDAR、抗Hu抗体双阳性AE患者的临床资料。结果患者女,9岁。以发热、头痛起病,随后出现惊厥,脑脊液常规生化检测异常,脑脊液单纯疱疹病毒1型DNA(+),头颅MRI示右侧颞叶为主区域受累,诊断为单纯疱疹病毒脑炎。数周后患者再发头痛,并出现情绪异常、上肢震颤,脑脊液单纯疱疹病毒1型DNA(-),抗NMDAR抗体IgG 1∶10,抗Hu抗体IgG(+),最终诊断为AE(抗NMDAR、抗Hu双阳)。给予丙种球蛋白及激素治疗后患者情绪稳定,震颤消失,头痛缓解。结论单纯疱疹病毒脑炎合并免疫性脑炎临床表现可能不典型,尽早完善相关抗体检测并及时复查有助于诊断,早期免疫治疗或可使患者获益。Objective To explore the clinical features of autoimmune encephalitis(AE)with double positive anti-NMDAR and anti-Hu antibodies in children following herpes simplex virus infection.Methods The clinical data of a child diagnosed with AE with double positive anti-NMDAR and anti-Hu antibodies after herpes simplex encephalitis was retrospectively analyzed.Results A 9-year-old female developed convulsions after fever and headache,routine examination of cerebrospinal fluid showed elevated CSF protein level and normal glucose level.CSF herpes simplex virus type 1 DNA was positive.Brain MRI showed extensive abnormal signal intensity in the right insula,temporal and parietal lobe.She was diagnosed as herpes simplex virus encephalitis.After antiviral,IVIG,and corticosteroids therapy,her symptoms improved.She had another headache several weeks later,then followed by emotional abnormalities and upper limb tremor.CSF herpes simplex virus type 1 DNA test was negative,AE-related antibody spectrum in CSF showed positive anti-NMDAR antibody IgG(1∶10)and anti-Hu antibody.The final diagnosis was AE with double positive anti-NMDAR and anti-Hu antibodies.The patient obtained emotional stability,limb tremor disappearance,and headache alleviation after IVIG and corticosteroids treatment again.Conclusions The clinical manifestations of AE following herpes simplex encephalitis may be atypical.Taking antibody tests at an earlier stage and rechecking them are helpful for the diagnosis,and those patients may benefit from early immunotherapy.

关 键 词：脑炎 单纯疱疹 儿童 自身免疫性脑炎 受体 N-甲基-D-天冬氨酸 抗Hu抗体 

分 类 号：R748[医药卫生—神经病学与精神病学]