中国实用神经疾病杂志2017，Vol.20Issue(20)：42-45,4.DOI:10.3969/j.issn.1673-5110.2017.20.010
抗NMDA受体脑炎7例临床分析
Clincial analysis of 7 cases of Anti-NMDA receptor encephalitis patients
摘要
Abstract
Objective The clinical manifestation ,diagnosis and treatment ,and prognosis of characteristics of IgG Antibody Positive of NMDA-receptor encephalitis patients determined by Indirect Immune Fluorescence Method were summarized here ,ai-ming to improve the diagnosis and treatment level of the encephalitis.Methods A retrospective analysis of the clinical manifesta-tion ,auxiliary check ,diagnosis and treatment ,and outcome for 7 encephalitis patients of NMDA receptor IgG positive resistance from Neurology hospital of the first affiliated hospital of Sun Yat-sen University between Jun 2015 and Aug 2016 was carried out. Results The encephalitis was more often appeared in young females.There were 5 cases in clinical manifestations of mental be-havior ,6 cases of epilepsy ,4 cases in disturbance of consciousness ,3 cases in cognitive decline ;Cerebrospinal fluid routine and bio-chemical results were abnormal in 4 cases ,while most of them had more WBC in which monocytes accounted for the major propor-tion and cerebrospinal fluid protein increased in 2 cases with not-too-high values ;Head MRI lesions :there were 4 cases in the lim-bic lobe ,1 case in the meninge ,and 2 cases with no lesions ,while characteristics of mild image and serious clinical manifestation were present ;Electroencephalogram (EEG) :4 patients had abnormal EEG.The results of five patients whose NMDA receptor IgG resistance in the serum and cerebrospinal fluid were both checked showed positive ,and the antibody titers of IgG in the serum were higher than those in the cerebrospinal fluid.Two special cases were found in this study :one was an encephalitis patient of NMDA receptor IgG positive resistance and lung cancer with hilus pulmonis and mediastinum metastases ,the other one complicat-ed with polycystic ovary syndrome.The majority of the patients were given hormone and (or) gamma globulin ,and individual plas-ma exchange treatment.A patient was received second-line therapy (cyclophosphamide and rituximab) when all kinds of first-line therapy were useless.All the patients were better after the treatments ,but remained symptoms were common in which 3 cases were cognitive decline and 2 cases were of no-automatic transport.The duration of hospital stays of these patients was (48.29 ± 46.48) days.Conclusion Clinical manifestations' features for anti-NMDA encephalitis patients were mental behavior disorders , epilepsy ,dystonia ,disturbance of consciousness and the decline in cognitive function.Limbic lobe lesions were often present in MR and Electroencephalogram can be seen abnormal.Virus encephaliti change occurred in CSF.Detection of IgG was very important for the diagnosis.After the diagnosing ,enough immunoglobulin therapy hormonal therapy and (or) plasma exchange therapy should be used immediately.If the effect was not satisfactory ,the therapy could be reused ,and even the immunosuppressive agents such as azathioprine could be used.Patients were better after the above treatments ,but remained symptoms were also common and the duration of hospital stays was long.关键词
抗NMDA受体脑炎/间接免疫荧光法/癫痫/精神异常/认知下降/意识障碍Key words
Anti-NMDA encephalitis/Indirect Immune Fluorescence Method/Epilepsy or seizures/Mental abnormality/Cognitive decline/Consciousness disturbance分类
医药卫生引用本文复制引用
曹黎明,吉晓天,王莹..抗NMDA受体脑炎7例临床分析[J].中国实用神经疾病杂志,2017,20(20):42-45,4.基金项目
深圳市卫生计生系统科研项目(20001507082) （20001507082）
