托珠单抗治疗1例儿童难治性抗N-甲基-D-天冬氨酸受体脑炎的病例报告及文献复习  

A Case Report and Literature Review of A Child with Refractory Anti-N-methyl-D-aspartate Receptor Encephalitis Treated with Tocilizumab

作　　者：张卫琴[1] 赵华伟[2] 王珍珍 高峰[1] 袁哲锋[1] ZHANG Weiqin;ZHAO Huawei;WANG Zhenzhen;GAO Feng;YUAN Zhefeng(Children’s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Department of Neurology,Hangzhou 310052,China;Children’s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Department of Pharmacy,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院,国家儿童健康与疾病临床医学研究中心神经内科,杭州310052 [2]浙江大学医学院附属儿童医院,国家儿童健康与疾病临床医学研究中心药剂科,杭州310052

出　　处：《中国现代应用药学》2024年第6期834-838,共5页Chinese Journal of Modern Applied Pharmacy

基　　金：国家自然科学基金青年科学基金项目(82003720);浙江省基础公益研究计划项目(LYY22H310002);浙江省新一轮卫生高层次人才培养工程(2022年度医坛新秀)。

摘　　要：目的 探讨托珠单抗治疗1例儿童难治性抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎的安全性及有效性,为治疗该疾病提供参考。方法 回顾性分析浙江大学医学院附属儿童医院1例儿童难治性抗NMDAR脑炎的临床表现、诊治经过及应用托珠单抗的安全性及有效性,并结合相关文献复习加以讨论。结果 该患儿应用了2次大剂量甲泼尼龙、丙种球蛋白及6次利妥昔单抗后临床症状无好转,应用6次托珠单抗后,改良Rankin量表(mRS)评分有改善,无不良反应。结论 托珠单抗作为升级的二线免疫治疗药物对难治性抗NMDAR脑炎治疗有效,耐受性好,是一种具备潜力的治疗手段之一。OBJECTIVE To explore the safety and efficacy of tocilizumab in the treatment of refractory anti-N-methyl-D-aspartate receptor encephalitis in children,and to provide reference for the treatment of this disease.METHODS The clinical manifestations,diagnosis and treatment,safety and efficacy of tocilizumab in a case of refractory anti-NMDAR encephalitis in Children’s Hospital,Zhejiang University School of Medicine were analyzed retrospectively,and the relevant literature was reviewed.RESULTS The clinical symptoms of the patient were not improved after 2 doses of methylprednisolone,immunoglobulin and 6 doses of rituximab.After 6 doses of tocilizumab,the modified Rankin scale(mRS)score was improved without adverse reactions.CONCLUSION Tocilizumab,as a escalation second-line immunotherapy,is effective and well tolerated in the treatment of refractory anti-NMDAR encephalitis.It is one of the potential therapeutic means.

关 键 词：托珠单抗 儿童 难治性 抗NMDAR脑炎 

分 类 号：R969.3[医药卫生—药理学]