自身免疫性脑炎的临床诊断和治疗

Clinical diagnosis and treatment of autoimmune encephalitis

目的分析研究自身免疫性脑炎的临床诊断和治疗措施，为自身免疫性脑炎的临床诊断及治疗提供新的思路及理论支持。方法选择96例自身免疫性脑炎患者，根据疾病类型不同分为抗VGKC脑炎组、抗NMDA脑炎组及边缘叶脑炎组，每组32例。对三组患者脑脊液、临床特征、性别及相关辅助检查等资料进行回顾性对比分析。结果抗NMDA脑炎组与抗VGKC脑炎组患者在免疫肿瘤效果、MRI、脑脊液、相关辅助检查、临床特征及性别等方面相比，鉴别诊断结果存在明显差异；边缘叶脑炎的相关疾病中非血管炎自身免疫性脑膜脑炎、桥本脑病及代谢性脑炎均会表现出意识障碍及困倦等症状；非血管炎自身免疫性脑膜脑炎、桥本脑病及代谢性脑炎和精神病MRI检测正常；非血管炎自身免疫性脑膜脑炎、桥本脑病、代谢性脑炎、进行性多灶性白质脑病、阿尔茨海默病、Wer-nicke-Korsakoff脑病脑脊液检查正常；进行性多灶性白质脑病、桥本脑病、代谢性脑炎、单疱脑炎及克罗伊茨费尔特-雅各布病可经诊断性检查明确。结论自身免疫性脑炎疾病类型繁多，应根据患者临床特征等情况进行诊断与鉴别，并实施有针对性的治疗措施。

ObjectiveTo analyze and study the clinical diagnosis and treatment of autoimmune encephalitis, in order to provide new ideas and theoretical support for clinical diagnosis and treatment of autoimmune encephalitis.MethodsNinety-six patients with autoimmune encephalitis were divided into anti VGKC encephalitis group, anti NMDA encephalitis group and edge leaf encephalitis group according to the different types of diseases, with 32 patients in each group. The cerebrospinal fluid, clinical features, gender and related auxiliary examination of the three groups were analyzed retrospectively.ResultsThere was significant difference in the differential diagnosis result of immune tumor, MRI, cerebrospinal fluid, related auxiliary examination, clinical features and gender between the anti NMDA encephalitis group and anti VGKC encephalitis group. The related diseases such as non vasculitis, autoimmune meningitis, Hashimoto’s encephalopathy and metabolic encephalitis had the symptoms of disturbance of consciousness and drowsiness. Non vasculitis autoimmune disease of the brain, Hashimoto’s encephalopathy, and metabolic encephalitis and psychosis MRI test were normal. Non vasculitis autoimmune meningitis, Hashimoto encephalopathy, metabolic encephalitis, progressive multifocal white matter encephalopathy, Alzheimer’s disease, Wer-nicke-Korsakoff’s disease cerebrospinal fluid examination were normal; Progressive multifocal leukoencephalopathy, Hashimoto’s encephalopathy, metabolic encephalitis, herpes simplex encephalitis and Creutzfeldt-Jacob brucellosis could be checked by the diagnosis of clear.ConclusionsThere are many kinds of autoimmune encephalitis diseases, which should be diagnosed and identified according to the clinical characteristics of the patients and the implementation of targeted treatment measures.