抗NMDA受体脑炎的临床分型和调查

Clinical Study of Anti-NMDA Receptor Encephalitis

目的了解抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎分型、疗效和预后。方法 2013年1月~2015年8月在武汉同济医院和襄阳市中心医院收集抗NMDAR脑炎确诊患者。抗体检测方法均采用转染细胞免疫荧光法(CBA),将抗NMDAR脑炎分为三种亚型,急性期治疗方案首选采用甲强龙冲击治疗、丙种球蛋白(0.4 g·kg^(-1)·d^(-1),5 d)、血浆置换治疗,二线治疗方案为环磷酰胺,随访方法为12个月改良Rankin量表。结果 32例患者完成研究,所有患者均没有发现畸胎瘤等肿瘤。32例患者采用甲强龙冲击治疗方案;对疗效不佳的23例患者又采用丙种球蛋白治疗;没有患者行血浆转换;9例患者采用免疫抑制剂治疗方案。12个月时改良Rankin量表(0~2分)转归为24例。结论采用国外学者提出的诊断标准、临床分型和治疗方案后大部分抗NMDAR脑炎患者取得较好疗效。

Objective To investigate the anti-N-methyl-D-aspartate receptor （NMDAR） encephalitis receptor type, effect and prognosis.Methods 2013.1-2015.8 Tongji Hospital in Wuhan and Xiangyang central hospital to collect anti-NMDAR encephalitis diagnosed patients. Antibody detection methods are used in the transfected cells by immunofluorescence （CBA）, will be divided into three subtypes of anti-NMDAR encephalitis, acute phase treatment of choice for the use of methylprednisolone pulse therapy, gamma globulin, plasma exchange treatment, second-line treatment options for cyclophosphamide, and methods of follow-up was modified Rankin scale of 12 months.Results 32 patients completed the study, all patients were not found teratoma and other tumors. 32 patients using methylprednisolone pulse therapy programs,then poor efficacy of 23 patients using gamma globulin treatment. No patients with plasma exchange, nine patients using immunosuppressive regimens. Outcome of 24 patients were modified Rankin （0-2） Scale after 12 months.Conclusion The use of standards of diagnosis and treatment, the majority of anti-NMDAR encephalitis achieve efficacy, and still need further study.