自身免疫性脑炎临床鉴别诊断及治疗研究

Clinical differential diagnosis and treatment of autoimmune encephalitis

目的探讨自身免疫性脑炎(AE)临床鉴别诊断及治疗,以期提高该病的临床诊治水平。方法回顾性分析2011年3月-2013年1月90例老年自身免疫性脑炎患者临床资料,将其分成3组,分别为抗VGKC脑炎、抗NMDA脑炎和边缘叶脑炎,比较3组年龄、性别、临床特点、脑脊液、辅助检查等的差异性,采用SPSS13.0软件进行统计分析。结果抗VGKC脑炎和抗NMDA脑炎好发性别、肿瘤的相关性、临床特点、辅助检查、脑脊液、MRI和免疫肿瘤效果等差异明显;边缘叶脑炎相关疾病中代谢性脑炎、桥本脑病、非血管炎自身免疫性脑膜脑炎均表现为困倦和意识障碍;代谢性脑炎、精神病、桥本脑病、非血管炎自身免疫性脑膜脑炎MRI检查正常;代谢性脑炎、阿尔茨海默病、精神病、非血管炎自身免疫性脑膜脑炎、Wernicke-Korsakoff脑病、进行性多灶性白质脑病脑脊液检查正常;诊断性检查可明确的有单疱脑炎、代谢性脑炎、克罗伊茨费尔特-雅各布病、桥本脑病、进行性多灶性白质脑病等。结论自身免疫性脑炎病种较多,在临床上鉴别时要依据患者的临床特点结合相关的检查等予以诊治。

OBJECTIVE To explore the clinical differential diagnosis and treatment of autoimmune encephalitis （AE） so as to improve the level of clinical diagnosis and treatment of the disease. METHODS The clinical data of 90 elderly patients with encephalitis who were treated in the hospital from Mar 2011 to Jan 2013 were retrospectively analyzed, then the subjects were divided into three groups： the VGKC encephalitis group, the NMDA encephalitis group, and the limbic lobe encephalitis group, the age, gender, clinical features, cerebrospinal fluid, and auxiliary examinations were observed and compared between the three groups, and the statistical analysis was performed with the use of SPSS13. 0 software. RESULTS Both the anti-VGKC encephalitis and anti-NMDA encephalitis belonged to the AE, with significant difference in the predisposing gender, tumor correlation, clinical features, auxiliary examination, cerebrospinal fluid, MRI, or immune tumor effect. Limbic lobe encephalitis was associated with metabolic encephalitis, and the hashimoto＇s encephalopathy in encephalitis and non-vascular inflammatory autoimmune meningoencephalitis were characterized by sleepiness and disturbance of consciousness. The metabolic encephalitis, mental disease, hashimoto encephalopathy, and non-vascular inflammatory autoimmune meningoencephalitis showed normal MRI; the level of the cerebrospinal fluid was normal in the patients with metabolic encephalitis, alzheimer＇s disease, psychosis, non-vascular inflammatory autoimmune meningoencephalitis, Wernicke-Korsakoff encephalopathy, or progressive multifocal leukoencephalopathy, the single blister encephalitis, metabolic encephalitis, CJD, hashimoto encephalopathy, and progressive multifocal leukoencephalopathy could be defined through the diagnostic examination. CONCLUSION The AE involves various types of diseases, the clinical differential diagnosis should be performed according to the clinical features.