摘要
目的探讨抗甲基-D-天冬氨酸受体(NMDAR)脑炎的临床特点及疗效。方法回顾性分析17例抗NMDAR脑炎患者的临床资料。结果17例均为急性或亚急性起病,其中13例(76.5%)于发病前1~2周有非特异性前驱感染症状。首发症状:痫性发作4例,精神行为异常3例。在整个病程中,出现痫样抽搐发作17例,出现锥体外系症状12例,自主神经功能障碍9例,不同程度意识障碍14例。17例脑脊液抗NMDAR抗体均为阳性,13例(76.5%)血液抗NMDAR抗体阳性;5例(29.4%)头颅MRI检查提示脑内非特异性改变;17例脑电图检查均提示异常,其中3例(18%)存在癫痫样放电。患者均给予静脉用丙种球蛋白(剂量0.4 g·kg^-1·d^-1)联合甲强龙及阿昔洛韦治疗。患者症状恢复,随访180 d未见复发和后遗症。结论抗NMDAR脑炎患者的临床症状复杂,采用脑电图评估具有较高的敏感度,免疫治疗有效,预后较好。
Objective To analyze the clinical characteristics and therapeutic effect of the patients with anti-n-methyl-d-aspartate receptor(NMDAR)encephalitis.Methods All clinical data of 17 cases(5 males and 12 females)of NMDAR encephalitis treated and diagnosed in our hospital were retrospectively analyzed.Results All the 17 cases were acute or subacute onset and 13(76.5%)had non-specific prodrome infection symptoms at 1 to 2 weeks before the disease.First symptoms:4 cases of epileptic seizure,3 cases of abnormal mental behavior.During the whole course of the disease,17 cases with seizures.12 cases of extrapyramidal symptoms,and 9 cases of autonomic nerve dysfunction.14 patients showed varying degrees of decrease in consciousness.All the 17(100%)cases were positive for anti-NMDAR antibodies in cerebrospinal fluid and 13(76.5%)were positive for anti-NMDAR antibodies in blood.MRI examination of the head suggested nonspecific changes in 5(29.4%)patients′brain.Electroencephalogram(EEG)examination revealed abnormal in 17(100%),3 of which had epileptiform discharge.All the patients were given intravenous immunoglobulin(dose 0.4 g·kg^-1·d^-1 combined with methylprednisolone and acyclovir).The symptoms of all patients improved,and no recurrence and sequelae were found in the follow-up.Conclusion The clinical symptoms of anti-NMDAR encephalitis are complex.EEG is sensitive to anti-NMDAR encephalitis.Immunotherapy against anti-NMDAR encephalitis is effective,and the prognosis is good.
作者
陈艇
张旭
江秀龙
周瑞玲
CHEN Ting;ZHANG Xu;JIANG Xiulong;ZHOU Ruiling(Department of Neurology,Fujian Provincial Hospital,Provincial Clinical College of Fujian Medical University,Fuzhou 350001,China)
出处
《福建医科大学学报》
2019年第6期391-396,共6页
Journal of Fujian Medical University
基金
福建省自然科学基金卫生联合项目(2018J01255)
