继发于单纯疱疹病毒脑炎的抗NMDAR和抗GABA_(BR)双阳性自身免疫性脑炎1例报告及文献复习  

Autoimmune encephalitis with double positive anti-NMDAR and anti-GABA_(BR) secondary to herpes simplex virus encephalitis:A case report and literature review

作　　者：赵仲艳[1] 徐志育 吴婵姬[1] 赵二义[1] 黄丹[1] 黄仕雄[1] ZHAO Zhongyan;XU Zhiyu;WU Chanji;ZHAO Eryi;HUANG Dan;HUANG Shixiong(Department of Neurology,People’s Hospital,Hainan Province,Affiliated Hainan Hospital,Hainan Medical College,Haikou 570311,China;Department of Intensive Care Unit,People’s Hospital,Hainan Province,Affiliated Hainan Hospital,Hainan Medical College,Haikou 570311,China)

机构地区：[1]海南省人民医院海南医学院附属海南医院神经内科,海南海口570311 [2]海南省人民医院海南医学院附属海南医院重症医学科,海南海口570311

出　　处：《吉林大学学报（医学版）》2024年第1期236-242,共7页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金项目(81860229);海南省科技厅院士团队创新中心项目(YSPTZX202135);海南省省级临床医学中心建设项目(琼卫医函[2021] 276号)。

摘　　要：目的:分析1例单纯疱疹病毒性脑炎(HSVE)继发抗N-甲基-D-天冬氨酸受体(NMDAR)和抗γ-氨基丁酸B型受体(GABA_(BR))双阳性自身免疫性脑炎(AE)患者的临床表现及诊疗经过,以提高临床医生对该类病的认识。方法:收集1例HSVE继发抗NMDAR和抗GABA_(BR)双阳性AE患者的临床资料,对其诊断和治疗经过进行总结,并结合相关文献进行复习。结果:患者,男性,36岁,以头痛起病,随后出现肢体抽搐,并进展为意识障碍。入院后脑脊液常规生化检测异常,脑脊液单纯疱疹病毒1型(HSV-1) IgG抗体阳性,脑脊液和血清NMDAR抗体检测阳性,头部磁共振成像(MRI)检查提示右侧枕叶白质异常信号,诊断为HSVE继发抗NMDAR脑炎。数月后患者出现精神行为异常、认知障碍和睡眠障碍等症状,血清NMDAR抗体和GABA_(BR)抗体均阳性,诊断为HSVE继发抗NMDAR脑炎和抗GABA_(BR)脑炎。给予激素冲击和静脉注射免疫球蛋白(IVIG)治疗后,患者病情好转出院。随访1年,患者精神症状完全消失,遗留轻度认知功能障碍。结论:HSVE抗病毒治疗有效的恢复期患者临床症状再度恶化时,应高度怀疑继发AE的可能,应尽快完善自身免疫性抗体检测,以期早期诊断,早期治疗,以改善患者预后。Objective:To analyze the clinical presentations and diagnostic and treatment process of one patient with autoimmune encephalitis(AE)with double positive anti-N-methyl-D-aspartate receptor(NMDAR)and anti-γ-aminobutyric acid B receptor(GABA_(BR))secondary to herpes simplex virus encephalitis(HSVE),and to improve the clinicians’awareness of this disease.Methods:The clinical data of one AE patient with double positive anti-NMDAR and anti-GABA_(BR) secondary to HSVE were collected,the diagnostic and therapeutic processes were summarized,and the relevant literatures were reviewed.Results:The patient,a 36-year-old male,developed a headache followed by limb convulsions,and progressed to disturbed consciousness.After admission,the routine biochemistry of the cerebrospinal fluid(CSF)was abnormal,and the herpes simplex virus-1(HSV-1)IgG antibody showed positive in the CSF;both CSF and serum tests for NMDAR antibodies were positive;the head magnetic resonance imaging(MRI)results showed abnormal signals in the right occipital white matter,leading to the diagnosis of HSVE secondary to anti-NMDAR encephalitis.Several months later,the patient experienced psychiatric behavior abnormalities,cognitive dysfunction,and sleep disorders,and both the serum NMDAR and GABA_(BR) antibodies showed positive results,prompting the diagnosis of HSVE secondary anti-NMDAR encephalitis and anti-GABA_(BR) encephalitis.After treatment with steroid pulse therapy and intravenous immunoglobulin(IVIG),the patient’s condition was improved and the patient was discharged.At one-year follow-up,the patient’s psychiatric symptoms had completely resolved,leaving mild cognitive impairment.Conclusion:If the clinical symptoms of the patients recovering from antiviral treatment for HSVE is worsened,secondary AE should be highly suspected;it is important to complete autoimmunity antibody testing as soon as possible for the early diagnosis and treatment to improve the prognosis of the patient.

关 键 词：单纯疱疹病毒性脑炎 抗N-甲基-D-门冬氨酸受体抗体 抗γ-氨基丁酸B型受体抗体 自身免疫性脑炎 

分 类 号：R512.3[医药卫生—内科学]