抗N-甲基-D-天门冬氨酸受体脑炎11例临床分析

Anti-N-methyl-D-aspartate receptor encephalitis： clinical analysis of 11 cases

目的 分析抗N-甲基-D-天门冬氨酸（NMDA）受体脑炎的临床表现、实验室及影像学资料,以提高对该病的认识.方法 对2013年1月至2015年2月在郑州大学人民医院神经内科就诊的11例抗NMDA受体脑炎患者的临床表现、实验室及影像学资料进行回顾性分析.结果 主要临床表现为癫痫9例,精神症状7例,运动障碍5例,自主神经功能障碍3例.11例脑脊液抗NMDA受体抗体均阳性,其中5例同时出现血清抗NMDA受体抗体阳性.1例合并肺癌.11例患者均接受免疫治疗,出院时4例基本恢复正常,7例存在不同程度的功能障碍.电话随访1 ～18个月,1例失访,10例随访患者中3例完全恢复,7例遗留不同程度的后遗症.结论 无精神病史的患者出现不明原因的精神症状伴痫性发作、记忆障碍、意识障碍、运动障碍、自主神经功能障碍等表现,应尽早做血清及脑脊液抗NMDA受体抗体检测,以便于早诊断、早治疗,改善预后.

Objective To analyze the clinical manifestation,laboratory findings,radiological data of anti-N-methyl-D-aspartate （NMDA） receptor encephalitis.Methods The clinical manifestation,laboratory findings,radiological data of eleven patients with anti-NMDA receptor encephalitis were analyzed.Results Main symptoms included epilepsy presented in 9 cases,psychiatric symptom in 7 cases,dyskinesia in 5 cases,autonomic dysfunction in 3 cases.The anti-NMDA receptor antibody was found in all the patients＇ cerebrospinal fluid （CSF）.No teratoma was detected in any of the patients,and 1 case had lung cancer.All the patients received immune therapy.And at discharge,4 cases recuperated generally,7 cases had different degrees of dysfunction.After telephone follow-up of 1-18 months,1 case was lost,3 cases had complete recovery,and 7 cases had different degrees of sequela.Conclusion When Patients without mental illness history presents with unexplained mental symptoms accompanied by seizures,memory impairment,disturbance of consciousness,movement disorders,autonomic dysfunction and other symptoms,anti-NMDA receptor antibodies studies in both serum and CSF should be done as early as possible in order to facilitate early diagnosis,early treatment and improve the prognosis.