抗NMDAR脑炎临床分析(附11例病例报告及文献复习)

Clinical analysis in patients with anti-N-methyl-D-aspartate receptor encephalitis:11 case reports and literature review

目的总结分析抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的临床特征以提高对该病的认识和重视。方法搜集国内206例抗NMDAR脑炎患者的报道,及在吉林大学白求恩第一医院就诊的11例抗NMDAR脑炎患者的详细病例资料,回顾性总结抗NMDAR脑炎的临床特点、实验室检查、治疗及预后,并结合文献予以分析讨论。结果患者多以抽搐或精神症状起病,病程中可出现意识障碍、运动障碍、中枢性通气不足、自主神经功能障碍等临床表现,头部MRI多无明显特异性改变,有的表现为皮质异常信号,脑电图常提示异常,血和(或)脑脊液NMDAR抗体阳性,多数预后较好。结论加强对该病的认识,尽早诊断及治疗有利于改善患者的预后。

Objective To summarize the clinical features of the anti-N-methyl-D-aspartate receptor （NMDAR） en- cephalitis combined with literatures and then raise the awareness and attention of the disease. Methods We collected 206 cases with anti-NMDAR encephalitis reported in China and analyzed 11 cases with anti-NMDAR encephalitis treated in the First Bethune Hospital of Jilin University. We summarized clinical manifestations,laboratory tests, treatment and prognosis of Anti-NMDAR encephalitis and then discussed combined with related references. Results Patients usually started with seizures and mental symptoms. The disease was characterized by consciousness disorders, dyskinesia, and autonomic insta- bility. Magnetic resonance imaging was normal or showed nonspecific cortical or subcortical FLAIR/T2 abnormalities. Elec- troencephalograms typically showed nonspccific generalized slow activity. Cerebrospinal fluid （CSF） and（or） serum anti- NMDAR antibodies were positive. Most patients had good prognosis. Conclusion Reinforced cognition, timely diagnosis and treatment would yield a favorable prognosis.