抗NMDA受体脑炎临床特征分析并文献复习

Analysis of Clinical Features of Anti-N-methyl-D-aspartate Receptor Encephalitis and A Literature Review

目的分析抗N-甲基-D-天冬氨酸(anti-N-methyl-D-aspartate,NMDA)受体脑炎的发病机制及临床特征,提高该病诊治水平。方法对抗NMDA受体脑炎1例的临床资料进行回顾性分析,并复习相关文献。结果本例因头痛10 h,高热、意识不清伴抽搐8 h入院。当地医院行头颅CT检查未见异常,予对症治疗后抽搐症状无缓解,遂入我院。拟诊为病毒性脑炎?癫痫持续状态,予相应治疗无好转,后行脑电图检查示弥漫性慢波、间断尖慢波,MRI检查示颅内片状异常信号影,腰椎穿刺脑脊液检查示细胞数及蛋白轻度异常,脑脊液及血液抗NMDA受体抗体检测阳性,明确诊断为抗NMDA受体脑炎。给予糖皮质激素冲击治疗1周,抽搐症状、发热缓解。结论抗NMDA受体脑炎临床少见,提高对该病的认识、及早行抗NMDA受体抗体检测是避免误诊的关键。

Objective To analyze pathogenesis and clinical features of anti-N-methyl-D-aspartate （NMDA） receptor encephalitis in order to improve levels of diagnosis and treatment. Methods Clinical data of one patient with anti- NMDA receptor encephalitis was retrospectively analyzed, and related literature was reviewed. Results The patient was admitted for 10 h of headache, high fever and unconsciousness associated by convulsions for 8 h. No abnormalities were found by head CT examination in local hospital, and convulsion did not relieved after symptomatic treatment, and then the patient transferred to our hospital. The patient was suspected as having viral encephalitis or status epilepticus, and symptoms did not improve after corresponding treatment, and then anti-NMDA receptor encephalitis was confirmed after finding diffuse and intermingled sharp slow wave by electrocardiogram examination （EEG） examination, intraeranial schistic abnormal signal intensity by MRI examination, slightly abnormal cell counts and protein by lumbar puncture and cerebrospinal fluid examination and positive anti- NMDA receptor antibodies in both blood and cerebrospinal fluid. Convulsion and fever were relieved after glucoeorticoids pulse therapy for one week. Conclusion Anti-NMDA receptor encephalitis is rare in clinic, and the key of avoiding misdiagnosis is to improve understanding of the disease and perform detection of anti-NMDA receptor antibodies as early as possible.