抗LGI1抗体脑炎和抗γ氨基丁酸-B受体脑炎的临床特点

Clinical characteristics of anti-LGI1 antibody encephalitis and anti-gamma aminobutyric acid-B receptor encephalitis

目的对抗LGIl抗体脑炎与抗GABABR脑炎的临床特点进行比较和总结。方法选取郑州大学第一附属医院2015-06—2017-06收治的12例抗LGIl抗体脑炎和13例抗GABA-B受体脑炎患者,总结其临床表现、脑电图、实验室检查、影像学表现,并进行随访,观察预后,比较分析各自特点。结果抗LGIl抗体脑炎与抗GABABR脑炎均有智能下降、精神症状、癫痫发作的特点,对免疫治疗反应较好。抗LGIl抗体脑炎往往有FBDS,且伴有低钠血症及自主神经系统症状,总体预后抗GABAB R脑炎好;抗GABABR脑炎合并肿瘤者预后不佳,除免疫治疗外还应积极治疗肿瘤。结论两种自身免疫性脑炎均对免疫治疗反应较好,抗LGI1抗体脑炎预后优于抗GABABR脑炎,部分抗GABABR脑炎患者合并肿瘤,预后除免疫治疗外还取决于对肿瘤的治疗。

Objective To compare and summarize the characteristics of anti LGIl antibody encephalitis and anti GABABR encephalitis.Methods 12 anti LGIl encephalitis patients and 13 anti GABA-B receptor encephalitis patients were treated in the First Affiliated Hospital of Zhengzhou University in the past 2 years.The clinical manifestations,electroencephalogram,laboratory examination and imaging findings were summarized,and the prognosis was observed,then the characteristics were compared and analyzed.Results The characteristics of the anti LGIl encephalitis and anti GABABR encephalitis are cognitive disorders,abnormal mental and behavior,seizures,and the response to immunotherapy of them was good.The anti LGIl antibody encephalitis often had FBDS,with hyponatremia and autonomic nervous system symptoms,the overall prognosis was better than the anti GABABR encephalitis,and the prognosis of anti GABABR encephalitis with tumor was poor.In addition to immunotherapy,the tumor should be treated actively.Conclusion Both of the two kinds of autoimmune encephalitis were good response to immunotherapy,the prognosis of anti LGI1 encephalitis is better than the anti GABABR encephalitis,and some anti GABABR encephalitis patients are found with tumor.The prognosis is also dependent on the treatment of tumor except the immunotherapy.