单纯疱疹病毒脑炎继发抗NMDAR脑炎的临床分析  

Clinical Analysis of Secondary Anti NMDAR Encephalitis Caused by Herpes Simplex Virus Encephalitis

作　　者：冀首鹏 张丹 黄月[3] Ji Shoupeng;Zhang Dan;Huang Yue(Xinxiang Medical University,Xinxiang,Henan 453003;Linying County People's Hospital,Luohe,Henan 462600;Henan Provincial People's Hospital,Zhengzhou,Henan 450000)

机构地区：[1]新乡医学院,河南新乡453003 [2]临颍县人民医院,河南漯河462600 [3]河南省人民医院,河南郑州450000

出　　处：《中外健康》2024年第6期4-6,共3页

基　　金：河南省医学科技攻关计划省部共建重点项目“NLRP3炎症小体介导的神经元焦亡在多发性硬化中的作用及机制研究”(SBGJ202102038)。

摘　　要：探讨单纯疱疹病毒脑炎(HSE)继发抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的临床特点、诊断方法、治疗效果及预后。选取2020年12月-2023年6月在河南省人民医院诊断为HSE继发抗NMDAR脑炎患者5例,回顾性分析其临床表现、实验室检查结果、神经影像学特征、治疗方法及随访情况。结果显示,5例患者中,HSE阶段,主要表现为癫痫发作、意识水平和认知功能下降等症状,抗NMDAR脑炎阶段,则均出现认知功能受损,部分伴有自主神经功能障碍或癫痫发作。脑脊液检查显示,HSE阶段白细胞和蛋白均升高,抗NMDAR脑炎阶段白细胞数部分正常或稍高,蛋白仍升高;影像学显示HSE阶段颞叶、海马等区域异常信号,抗NMDAR脑炎阶段部分改善。免疫治疗后,3例预后良好,2例预后不良。研究发现,HSE可导致抗NMDAR脑炎的发生,临床应对HSE后出现的神经系统症状保持警惕,以临床表现、脑脊液检测、神经影像学等为诊断的主要方法,及早进行相关检查及免疫治疗。To explore the clinical characteristics,diagnostic methods,treatment efficacy,and prognosis of secondary anti N-methyl-Daspartate receptor(NMDAR)encephalitis in herpes simplex virus encephalitis(HSE).Five patients diagnosed with HSE secondary anti NMDAR encephalitis at Henan Provincial People's Hospital from December 2020 to June 2023 were selected for retrospective analysis of their clinical manifestations,laboratory test results,neuroimaging characteristics,treatment methods,and follow-up.The results showed that among the 5 patients,in the HSE stage,the main symptoms were seizures,decreased consciousness level,and cognitive function.In the anti NMDAR encephalitis stage,cognitive function was impaired,and some patients had autonomic dysfunction or seizures.Cerebrospinal fluid examination showed an increase in white blood cells and protein levels during the HSE stage,while the white blood cell count was partially normal or slightly higher during the anti NMDAR encephalitis stage,with protein levels still elevated;Imaging shows abnormal signals in the temporal lobe,hippocampus,and other regions during the HSE stage,and partial improvement during the anti NMDAR encephalitis stage.After immunotherapy,3 cases had a good prognosis and 2 cases had a poor prognosis.Research has found that HSE encephalitis can lead to the occurrence of anti NMDAR encephalitis.Clinical attention should be paid to the neurological symptoms that occur after HSE,and clinical manifestations,cerebrospinal fluid testing,neuroimaging,and other diagnostic methods should be the main methods.Relevant examinations and immunotherapy should be carried out early.

关 键 词：脑炎 N-甲基-D-天冬氨酸受体 单纯疱疹病毒 

分 类 号：R512.3[医药卫生—内科学]