抗N-甲基-D-天冬氨酸受体脑炎29例误诊分析

Misdiagnosis analysis of 29 cases of anti-N-methyl-D-aspartic acid receptor encephalitis

目的提高对抗N-甲基-D-天冬氨酸(NMDA)受体脑炎的认识,减少临床误诊。方法对2013年11月~2016年10月成都上锦南府医院-华西上锦分院神经内科收治的29例确诊的抗NMDA受体脑炎病例进行回顾性分析,总结误诊的原因。结果 29例抗NMDA受体脑炎初期均出现误诊,平均误诊时间17 d,住院时间37 d。进行抗NMDA受体抗体检测确诊抗NMDA受体脑炎后,予以丙种球蛋白和/或糖皮质激素治疗,多数患者预后较好。少数发病初期即出现昏迷、难治性癫痫持续状态的重症患者预后较差。结论抗NMDA受体脑炎临床误诊率极高,早期行CSF和/或血液抗NMDA受体抗体检测对于该病的确诊及指导治疗具有重要的临床价值。

Objective To improve the awareness of anti-N-methyl-D-aspartate （NMDA） receptor encephalitis and reduce the clinical misdiagnosis. Methods Clinical data of 29 cases anti-NMDA receptor encephalitis admitted to the department of neurology, Cheng Du Shang Jin Nan Fu Hospital West China Hospital during November 2013 and October 2016 were retrospective analyzed, and summarized the causes of misdiagnosis. Results All of the 29 patients were misdiagnosed early, the median misdiagnosis period was 17 d and median length of stay in hospital was 37 d. Anti-NMDA receptor encephalitis was confirmed by the positive of anti-NMDA receptor antibody in CSF and/or serum. The prognosis of most patients was better with glucocorticoids and/or immune globulin therapy. The prognosis of severe patients with coma and refractory status epilepticus in the early time is worse. Conclusion The misdiagnosis rate of anti-NMDA receptor encephalitis is extremely high, and hospital stays and misdiagnosis period were positively correlated, the testing of anti-NMDA receptor antibody in CSF and/or serum in the early time has important clinical value for the diagnosis and guidance of the disease.