儿童抗N-甲基-D-天冬氨酸受体脑炎的临床特征及其复发相关因素分析  

Clinical Features and Recurrence-related Factors of Anti-N-methyl-D-aspartate Receptor Encephalitis in Children

作　　者：张凯[1] 王彩贞 刘康[1] 孙素真[1] ZHANG Kai;WANG Caizhen;LIU Kang;SUN Suzhen(Department of Neurology,Hebei Children's Hospital,Hebei Medical University,Shijiazhuang 050000,China;The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学附属河北省儿童医院神经内科,河北省石家庄市050000 [2]河北医科大学第二临床医学院,河北省石家庄市050000

出　　处：《中国全科医学》2022年第21期2629-2634,共6页Chinese General Practice

摘　　要：背景目前抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患儿复发比例较高,而相关研究较少,大部分医务人员对其认识不足。目的对复发和非复发的抗NMDAR脑炎患儿进行对比研究,以提高临床医生对抗NMDAR脑炎及其复发相关因素的认识,进而为抗NMDAR脑炎患儿的个性化治疗及降低复发率提供依据。方法回顾性分析2016年1月至2021年12月于河北医科大学附属河北省儿童医院神经内科诊断为抗NDMAR脑炎的54例住院患儿的临床资料,根据患儿复发情况分为非复发组和复发组。分析抗NDMAR脑炎患儿临床特征,包括性别和年龄分布、发病时间、临床症状及体征、脑脊液常规检查情况、影像学检查情况、脑电图检查情况、免疫学检查情况、治疗及预后情况,并对两组的上述相关指标进行比较。结果54例患儿男女比为1.16∶1,学龄期组(≥7岁)占比较高为51.8%;发病时间以夏季(6—8月)占比较高(33.3%);临床症状表现多样,最常见的临床症状为癫痫发作,占61.1%;38例(70.4%)患儿出现脑脊液常规检查结果异常,主要表现为脑脊液白细胞升高和蛋白轻度升高;25例(46.3%)患儿颅脑磁共振成像(MRI)检查显示异常,异常信号最常见于额叶,其次为基底核及丘脑;6例(11.1%)给予免疫球蛋白治疗≥2轮,5例(9.3%)给予激素冲击治疗≥2轮,7例(13.0%)给予二线免疫治疗,31例(57.4%)给予抗癫痫药治疗;26例(48.1%)达到完全缓解。两组性别和年龄分布情况、发病时间、脑脊液常规检查结果、颅脑MRI检查结果异常比例、视频脑电图检查结果、CD;T淋巴细胞、CD;/CD;、总B淋巴细胞、IgA、IgM、IgG比较、治疗前病程、免疫球蛋白治疗≥2轮比例、激素冲击治疗≥2轮比例、二线免疫治疗比例、应用抗癫痫药比例、出院时改良的Rankin量表评分(mRS)、完全缓解比例比较,差异无统计学意义(P>0.05)。复发组总T淋巴细胞及CD;T淋巴细胞较未复发组降低(P<0.05Background At present,the recurrence rate of children with anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis is relatively high.But there are relatively few studies and most medical staff are not aware of it.Objective A comparative study of children with recurrent and non-recurrent anti-NMDAR encephalitis was conducted to improve clinicians’understanding of anti-NMDAR encephalitis and its recurrence-related factors,in order to provide evidence for individualized treatment of children with anti-NMDAR encephalitis and reduce the recurrence rate.Methods The clinical data of 54 hospitalized children diagnosed with anti-NDMAR encephalitis in the Department of Neurology,Hebei Children’s Hospita,Hebei Medical University from January 2016 to December 2021 were retrospectively analyzed.According to the recurrence situation,the children were divided into non-recurrence group and recurrence group.The clinical characteristics of children with anti-NDMAR encephalitis were analyzed,including gender and age distribution,onset time,clinical symptoms and signs,routine examination of cerebrospinal fluid,imaging examination,electroencephalography,immunological examination,treatment and prognosis.The above-mentioned related indicators of the two groups were compared.Results The male-to-female ratio of the 54 children was 1.16∶1,and the school-age group(≥7 years old)accounted for 51.8%;The onset time was higher in summer(June-August)(33.3%).The clinical symptoms were diverse,and the most common clinical symptom was epilepsy,accounting for 61.1%;38 cases(70.4%)had abnormal cerebrospinal fluid routine examination results,mainly manifested as increased leukocyte and mildly increased protein in cerebrospinal fluid;MRI examination of brain of 25 children(46.3%)showed abnormal signals,the most common abnormal signal was in the frontal lobe,followed by the basal ganglia and thalamus;6 cases(11.1%)were given immunoglobulin for≥2 rounds,and 5 cases(9.3%)were given hormone shock≥after 2 rounds,7 cases(13.0%)received second-line

关 键 词：抗N-甲基-D-门冬氨酸受体脑炎 儿童 复发 疾病特征 

分 类 号：R739.4[医药卫生—肿瘤]