抗N-甲基-D-天冬氨酸受体脑炎与病毒性脑炎临床特点分析  

The analysis of clinical features of anti-N-methyl-D-aspartate receptor encephalitis and viral encephalitis

作　　者：周永吉 林彩秀 陈嘉伊 蒋琳[2] 殷聪国[2] Zhou Yongji

机构地区：[1]浙江大学医学院附属杭州市第一人民医院城北院区,310022 [2]浙江大学医学院附属杭州市第一人民医院,310003

出　　处：《浙江临床医学》2022年第9期1272-1274,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省自然科学基金资助项目(LQ21H090005)。

摘　　要：目的探讨抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎与病毒性脑炎(VE)鉴别诊断的临床思路.方法回顾性分析2014年1月至2020年1月抗NMDAR脑炎和VE患者的临床资料,比较二者的临床表现、脑脊液改变、脑电图、影像学检查及治疗转归.结果抗NMDAR脑炎10例,VE53例.两组患者发热、头痛比较差异无统计学意义(P>0.05),抗NMDAR脑炎组癫痫持续状态、精神行为异常、认知功能障碍、意识障碍及中枢性低通气发生率高于VE组(P<0.05);抗NMDAR脑炎组脑脊液压力高于VE组(P<0.05),而影像学异常率低于VE组(P<0.05).抗NMDAR脑炎组免疫治疗反应良好,癫痫缓解率高(85.71%),而VE组有一部分癫痫反复发作,癫痫缓解率低(35.29%)(P<0.05).结论抗NMDAR脑炎和VE有共性也有差异,结合早期临床表现和影像学,对指导临床治疗有一定意义.Objective To investigate the clinical thought for diferential diagnosis of anti-NMDAR encephalitis and viral encephaltis(VE).Methods Clinical data of anti-NMDAR encephalitis and viral encephalitis patients hospitalized in the Department of Neurology and Intensive Care Medicine of Hangzhou Fist People's Hospital from January 2014 to January 2020 were retrospcctively analyzed.The clinical manifestations especially seizures,cerebrospinal fluid examination,electroencephalogram,neurological imaging and outcome were compared between the two groups.Results Ten anti-NMDAR encephalitis and fty-three patients with VE were enolled in the study.By comparing the clinical characteristics of the two group,there was no dfference in fever and headache.But epilepticus staus,pschitric disorder,cognitive dysfunction,disturbance of consciousness and central hypopnea were more common in anti-NMDAR encephalitis patiens(P<0.05).The cerebrospinal fluid pressure was higher in anti-NMDAR encephalis group than that in VE group(P<0.05),and the incidence of MRI abnormity was lower in anti-NMDAR encephaltis group(P<0.05).The efeet of anti-immunotherapy in anti-NMDAR encephalitis was good,the seizure was better contolld with high remision rat(85.71%).while scizure was ceasy to relapse in VE group.Conclusion There are similrities and differences between anti NMDAR encephalitis and vinal encephalitis.Combined with early clinical feaures and imaging diferences,it is of certain signifcance to guide clinical treatment.

关 键 词：抗NMDAR脑炎 病毒性脑炎 临床特点 癫痫 

分 类 号：R512.3[医药卫生—内科学] R742.9[医药卫生—临床医学]