儿童抗N-甲基-D-天冬氨酸受体脑炎认知障碍临床随访研究  

Clinical follow-up study of cognitive impairment in children with anti-N-methyl-D-aspartate receptor encephalitis

作　　者：吴文晓 吴汶霖 李小晶 侯池 曾意茹 彭炳蔚 朱海霞 田杨 赵原 陈文雄 WU Wenxiao;WU Wenlin;LI Xiaojing;HOU Chi;ZENG Yiru;PENG Bingwei;ZHU Haixia;TIAN Yang;ZHAO Yuan;CHEN Wenxiong(Department of Neurology,Guangzhou Women and Children′s Medical Center,Guangzhou 510120,Guangdong,China)

机构地区：[1]广州市妇女儿童医疗中心神经内科,广东广州510120

出　　处：《临床儿科杂志》2023年第3期219-223,共5页Journal of Clinical Pediatrics

基　　金：广州市卫生健康科技一般引导项目(No.20211A011027)。

摘　　要：目的 随访评估南方地区儿童抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎恢复期的认知功能。方法 回顾性分析2016至2021年诊治的抗NMDAR脑炎患儿的临床资料,依据急性期改良Rankin量表(mRS评分)得分分为重症组(mRS>3分)及非重症组(mRS≤3分),分析所有患儿急性期出院时及末次随访的韦氏智力测试结果。结果 共33例患儿纳入分析,男15例、女18例,首次发病年龄为6.0(5.0~9.0)岁。急性期临床表现以抽搐(31例)、精神行为异常(28例)、运动障碍(28例)为主。自急性期出院至末次随访时间为12.0(4.0~33.0)月,末次随访时mRS评分为0.0(0.0~0.0),韦氏智测总智商为82.4±12.1,言语理解指数为85.6±16.7,工作记忆指数为84.7±13.5,加工速度指数为83.5±11.0。患儿总智商及各分测验均低于平常水平。末次随访时重症组与非重症组总智商值及各指数之间差异无统计学意义(P>0.05)。10例患儿接受了2次韦氏智力测试,第1次测试时间为首次发病出院后3.0(1.0~5.7)月,第2次为首次发病出院后21.0(15.5~28.0)月;第2次测试的总智商和言语理解指数均高于第1次,差异有统计学意义(P<0.05)。结论 儿童抗NMDAR脑炎患儿在恢复期存在认知障碍,建议定期行智力测试评估并及时给予合理干预。Objective To evaluate and follow-up the cognitive function during convalescence of anti-N-methyl-Daspartate receptor(NMDAR)encephalitis in children in southern China.Methods The clinical data of children with anti-NMDAR encephalitis diagnosed and treated from 2016 to 2021 were retrospectively analyzed.According to the modified Rankin Scale(mRS Score)in the acute stage,the patients were divided into the severe group(mRS>3)and the non-severe group(mRS≤3).The results of Wechsler intelligence scale at the acute stage discharged from hospital and last follow-up were collected and analyzed.Results A total of 33 children(15 boys and 18 girls)were included in the analysis.The age of first onset was 6.0(5.0~9.0)years.The clinical features in the acute stage were mainly convulsion(n=31),psycho behavioral symptoms(n=28),and movement disorder(n=28).The time from discharge to the last follow-up was 12.0(4.0-33.0)months.At the last follow-up,the mRS Score was 0.0(0.0~0.0),the full-scale intelligence quotient(FSIQ)was 82.4±12.1,the verbal comprehension index(VCI)was 85.6±16.7,the working memory index(WMI)was 84.7±13.5,and the processing speed index(PSI)was 83.5±11.0.The FSIQ and subtests scores of the children were lower than the normal level.No statistically significant differences was found in FSIQ and subtests between the severe group and the non-severe group(P>0.05)at the last follow-up.Ten children received two Wechsler intelligence tests.The time of the first test was 3.0(1.0-5.7)months after the discharge of the first onset,and the time of the second test was 21.0(15.5-28.0)months after the discharge of the first onset.FSIQ and VCI of the second test were higher than those of the first test,and the difference was statistically significant(P<0.05).Conclusions Children with anti-NMDAR encephalitis have cognitive impairment in the convalescence period.It is recommended to conduct regular intelligence assessment and timely reasonable intervention.

关 键 词：抗N-甲基-D-天冬氨酸脑炎 认知功能 儿童 

分 类 号：R742.9[医药卫生—神经病学与精神病学]