血浆置换治疗抗N-甲基-M-天冬氨酸受体脑炎的安全性分析

Safety of plasma exchange therapy in patients with anti-NMDA receptor encephalitis

目的 探讨血浆置换（PE）治疗抗N-甲基-M-天冬氨酸（NMDA）受体脑炎的安全性和可操作性.方法 前瞻性观察研究2012年1月至2015年1月收入宣武医院神经内科监护病房的抗NMDA受体脑炎患者PE治疗的不良反应和疗效.结果 共纳入9例患者接受PE治疗54次,全部（100％）患者经过PE治疗后CSF和（或）血清中NMDA受体抗体滴度均有减低或转为阴性,共5例（55.5％）患者临床好转.PE不良反应依次为：不自主运动增加、低血压、PE管路凝血、体温升高、过敏反应和深静脉置管处管口周围渗血.无致死的严重不良反应.结论 PE可有效治疗抗NMDA受体脑炎,并且安全可行.

Objective To explore the safety of plasma exchange （PE） therapy in patients with anti-NMDA receptor encephalitis.Methods Prospective reviews were conducted for the adverse events and therapeutic efficacies of PE therapy in 9 patients with anti-NMDA receptor encephalitis admitted into neurointensive care unit from January 2012 to January 2015.Results A total of 54 PE procedures were performed.The NMDA receptor antibody titer of cerebrospinal fluid （CSF） and/or sera in 9 patients （100%） decreased or turned negative.Five patients （55.5%） demonstrated clinical improvement after PE therapy.And clinical complications included frequent involuntary movements,hypotension,coagulation of PE channel,febricity,allergic response and errhysis around peripheral venous access.Conclusion PE is effective,safe and well-tolerated in patients with anti-NMDA receptor encephalitis.