抗N-甲基-D-天冬氨酸受体脑炎14例临床分析  

Clinical analysis of 14 anti-NMDAR encephalitis cases

作　　者：何敏[1] 黄贤贵[1] 覃彬 陈红[1] 王栋慧[1] 唐毅斯 杨明秀[1] He Min;Huang Xiangui;Qin Bin;Chen Hong;Wang Donghui;Tang Yisi;Yang Mingxiu(Department of Neurology,the Liuzhou People's Hospital,Afiliated to Guangxi Medical University,Guangxi 545006,China)

机构地区：[1]广西医科大学附属柳州市人民医院神经内科,广西545006

出　　处：《脑与神经疾病杂志》2023年第9期550-556,共7页Journal of Brain and Nervous Diseases

基　　金：广西壮族自治区卫生健康委员会计划课题(Z20210231);柳州市科技计划项目(2021CBC0109)。

摘　　要：目的 分析14例抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患者的临床资料,总结其临床特点。方法 纳入14例确诊为抗NMDAR脑炎的患者为研究对象,收集患者的人口统计学、临床表现及实验室检查等临床资料进行分析,使用改良Rankin量表(mRS)对其神经功能进行评价。结果 本研究14例患者中男性6例,女性8例,平均年龄(9.90±7.16)岁。85.71%患者表现为精神行为异常,64.29%有癫痫发作。重症患者与普通患者脑脊液抗NMDAR抗体滴度差异无统计学意义。所有患者均接受一线免疫治疗,有4例患者接受了二线免疫治疗,治疗有效率78.57%(P<0.05),随访复发率为21.43%。其中重症患者组治疗总有效率40.00%。结论抗NMDAR脑炎常见于青少年及儿童,以精神行为异常、癫痫发作、运动功能障碍等为主要临床表现,早期进行免疫治疗有利于患者的预后。对于重症抗NMDAR脑炎患者,适时采用二线免疫治疗及多学科综合治疗可能是提高治疗有效率的途径之一。Objective To analyze the clinical data and summary the clinical characteristics of 14 patients with anti-N-methyl-D-Aspartate receptor(NMDAR)encephalitis.Methods 14 cases of anti-NMDAR encephalitis were incorporated.The demography,clinical manifestations and laboratory examination results were collected,the modified Rankin Scale(mRS)was used to evaluate the neurological function.Results Among 14 patients,there were 6 males and 8 females,with a median age of 9.90±7.16.85.71%of the patients showed abnormal mental behavior and 64.29%had seizures.There was no statistical difference in the titer of CSF anti-NMDAR antibody between severe patients and normal patients.All patients were received the first-line immunotherapy treatment while 4 cases were given a second-line therapies.The treatment effectiveness was 78.57%(P<0.05)meanwhile the recurrence rate was 21.43%.The treatment effectiveness of severe cases group was 40.00%.Conclusion Anti-NMDAR encephalitis is prevalent in adolescents and children with the main clinical feature of abnormal mental behavior,seizures as well as motor dysfunction.Early immunotherapy treatment benefits to a better prognosis.It's may be one of the effective ways to relieve the neurologic impairment by starting up second-line immunotherapy timely and multimodality therapies in critically anti-NMDAR encephalitis patients.

关 键 词：自身免疫性脑炎 抗NMDAR脑炎 免疫治疗 

分 类 号：R512.3[医药卫生—内科学]