自身免疫性脑炎症状特点及易误诊为精神相关问题的原因分析  

Symptom characteristics of autoimmune encephalitis and the causes of misdiagnoses as mental-related problems

作　　者：蔡占魁 陈方斌 李娜 周菲菲 符丹萍 徐珺杰 阎同军 高志勤 李光耀 肖阳 CAI Zhan-kui;CHEN Fang-bin;LI Na;ZHOU Fei-fei;FU Dan-ping;XU Jun-jie;YAN Tong-jun;GAO Zhi-qin;LI Guang-yao;XIAO Yang(The 904th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army,Changzhou 213003,China)

机构地区：[1]联勤保障部队第九〇四医院常州医疗区,江苏常州213003

出　　处：《临床精神医学杂志》2024年第2期118-121,共4页Journal of Clinical Psychiatry

基　　金：军区医学科技创新课题(15MS017);联勤保障部队第904医院院管课题(MS202129)。

摘　　要：目的:探讨总结自身免疫性脑炎的症状特点并分析易误诊的原因。方法:回顾性研究联勤保障部队第九〇四医院2015年6月至2021年6月收治的自身免疫性脑炎患者15例,并结合文献进行分析。结果:15例患者中男性9例,女性6例。10例为抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎,2例为抗γ-氨基丁酸B型受体(GABA BR)抗体相关脑炎,2例为抗富亮氨酸胶质瘤失活蛋白1(LGI1)抗体相关脑炎,1例为抗代谢型谷氨酸受体5(mGluR5)脑炎。15例患者中有7例存在前驱感染样症状,5例起病前存在精神刺激因素;15例中出现精神行为异常13例,癫痫强直阵挛发作7例,不自主运动6例,认知障碍12例,意识障碍6例,自主神经功能障碍9例。13例精神行为异常患者有12例症状缺乏典型性。临床医生对自主神经功能障碍的识别率较低,9例中有7例被考虑为药物或感染所致。15例患者中病重6例,病重的主要原因为意识障碍、中枢性通气不足、肺部感染。15例患者中有10例头颅磁共振成像(MRI)存在新发异常病灶。脑脊液检查示压力异常7例、蛋白异常6例、细胞数异常4例。脑电图3例未做,余12例中有4例正常,8例呈慢波,病例6同时存在尖波。结论:自身免疫性脑炎多伴精神症状,不典型的精神症状尤其伴早期应激心理因素者易被误诊为功能性精神障碍,且在治疗过程中,自主神经功能障碍的症状易被考虑为药物所致。Objective:To discuss and summarize the symptoms and characteristics of autoimmune encephalitis,and to analyze the reasons of misdiagnoses.Method:A retrospective study was conducted on 15 patients with autoimmune encephalitis admitted to the 904th Hospital of the Joint Logistics Support Force from June 2015 to June 2021,and the literature was analyzed.Results:Among the 15 patients,9 were male and 6 were female.10 cases were anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis,2 cases were anti-γ-aminobutyric acid type B receptor(GABA BR)antibody-related encephalitis,and 2 cases were anti-LGI1 One case was anti-metabotropic glutamate receptor 5(mGluR5)encephalitis.Among the 15 patients,7 had prodromal infection-like symptoms,5 had mental stimuli before onset,13 had abnormal mental behavior,7 had tonic-clonic seizures,6 had involuntary movements,and 12 had cognitive impairment.There were 6 cases of disturbance of consciousness and 9 cases of autonomic dysfunction.Of the 15 patients,6 were seriously ill.The main reasons for the severe illness were disturbance of consciousness,central hypoventilation,and pulmonary infection.Among the 15 patients with brain magnetic resonance imaging(MRI),10 had new abnormal lesions,7 had abnormal cerebrospinal fluid pressure,6 had abnormal protein,and 4 had abnormal cell count.Electroencephalography was not done in 3 cases.In the remaining 12 cases,4 cases were normal,8 cases showed slow waves,and 6 cases had sharp waves at the same time.Conclusion:Autoimmune encephalitis is often accompanied by psychiatric symptoms,and atypical psychiatric symptoms,some with early stress psychological factors inparticular,which are the reasons why it is easily misdiagnosed as functional mental disorders.In the course of treatment,the manifestations of autonomic dysfunction are easily considered as drug-induced.

关 键 词：自身免疫性脑炎 症状特点 精神障碍 

分 类 号：R749.1[医药卫生—神经病学与精神病学]