Ⅰ型单纯疱疹病毒性脑炎继发抗NMDAR脑炎1例报告并文献复习  

Anti-NMDAR Encephalitis Secondary to Herpes Simplex Virus Type Ⅰ Encephalitis:a Case Report and Literature Review

作　　者：刘亚娜 孟永胜 张喜丰 石宏 LIU Ya-na;MENG Yong-sheng;ZHANG Xi-feng;SHI Hong(Department of Pediatrics,Kaifeng Central Hospital,Kaifeng 475000,China)

机构地区：[1]开封市中心医院儿科,河南开封475000

出　　处：《实用临床医学（江西）》2022年第4期52-56,共5页Practical Clinical Medicine

摘　　要：目的 探讨Ⅰ型单纯疱疹病毒性脑炎继发抗NMDAR脑炎的临床表现及诊治方法。方法 回顾性分析1例Ⅰ型单纯疱疹病毒性脑炎继发抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患儿的临床资料,并进行文献复习。结果 患儿,女,8个月,体重7 kg,临床表现有发热、肢体障碍、抽搐、运动发育倒退、吞咽功能损伤、表情淡漠等,头颅及全脊柱磁共振成像(MRI)+弥散加权成像(DWI)提示多脑叶、脑干及脊髓受累,予糖皮质激素和人血丙种球蛋白冲击等对症治疗后体温正常。出院第6天再次出现体温波动,逐渐出现强直状态,吞咽功能消失,在脑脊液及血清中检测出抗NMDAR抗体弱阳性,诊断为自身免疫性脑炎——抗NMDAR脑炎。再次使用甲泼尼龙琥珀酸钠(20 mg·kg^(-1)·d^(-1))联合人血丙种球蛋白(1 g·kg^(-1)·d^(-1))冲击治疗,连续应用3 d,甲泼尼龙琥珀酸钠延长应用至7 d,后每3 d减量5 mg·kg^(-1)·d^(-1),直至口服醋酸泼尼松片(2 mg·kg^(-1)·d^(-1)),3个月逐渐减停。患儿体温正常,强直状态消失,吞咽功能完全恢复,表情多样,未再抽搐,肢体障碍仍存在。结论 Ⅰ型单纯疱疹病毒性脑炎后出现体温波动、强直状态、吞咽功能消失等表现,应注意继发抗NMDAR脑炎,尽早完善血清及脑脊液中抗NMDAR抗体等监测,及早进行个体化的免疫治疗,促使神经功能恢复。Objective To investigate the clinical manifestations,diagnosis and treatment of anti-N-methyl-D-aspartate receptor(NMDAR) encephalitis secondary to herpes simplex virus type Ⅰ encephalitis.Methods The clinical data of a case of anti-NMDAR encephalitis secondary to herpes simplex virus type Ⅰ encephalitis were retrospectively analyzed,and the related literature were reviewed.Results The 8-month-old female infant weighing 7 kg presented with fever,limb disorders,convulsion,motor development regression,swallowing function impairment,and apathetic expression.Head and whole spine MRI+DWI showed the involvement of multiple lobes,brainstem and spinal cord.The body temperature returned to normal after symptomatic treatment with glucocorticoid and human blood gamma globulin shock.However,the body temperature fluctuated again,the ankylosis gradually occurred,and the swallowing function disappeared on the 6th day after discharge.The infant was diagnosed with autoimmune encephalitis——anti-NMDAR encephalitis after weakly positive anti-NMDAR antibodies were detected in cerebrospinal fluid and serum.After the combination of methylprednisolone sodium succinate(20 mg·kg^(-1)·d^(-1)) and human blood gamma globulin(1 g·kg^(-1)·d^(-1)) was used again for shock therapy for 3 days,methylprednisolone sodium succinate was extended to 7 days.Then,the dosage was reduced by 5 mg·kg^(-1)·d^(-1) every 3 days until the oral administration of prednisolone acetate tablets(2 mg·kg^(-1)·d^(-1)),which were gradually stopped after 3 months.The body temperature was normal with disappeared rigidity,recovered swallowing function and diverse facial expression.Furthermore,no convulsion occurred in the infant.However,the limb disorders still existed.Conclusion When infants with herpes simplex virus type Ⅰ encephalitis present with body temperature fluctuation,ankylosis and swallowing function disappearance,attention should be paid to the secondary anti-NMDAR encephalitis.The monitoring of anti-NMDAR antibodies in serum and cerebrospinal

关 键 词：Ⅰ型单纯疱疹病毒 急性脑炎 脊髓炎 自身免疫性脑炎 

分 类 号：R748[医药卫生—神经病学与精神病学]