120例抗NMDAR脑炎患者NMDAR表达情况的回顾性分析

Retrospective analysis of NMDAR expression in 120 patients with anti-NMDAR encephalitis

目的探究120例抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患者的NMDAR表达情况及意义。方法选取我院2014年1月至2016年6月收治的抗NMDAR脑炎患者120例为研究对象。回顾性分析患者的临床症状、辅助检查、治疗以及预后情况,测定和分析治疗前、后血清与脑脊液NMDAR表达情况。结果精神异常症状、惊厥症状、自主神经功能紊乱、记忆障碍、意识障碍、语言障碍、前驱症状是抗NMDAR脑炎患者的主要临床症状,所占比例分别为92.50%、69.17%、68.33%、61.67%、58.33%、54.17%、53.33%。治疗后,患者的血清NMDAR与脑脊液NMDAR水平均较治疗前降低(P<0.05)。经24个月随访,99例(82.50%)患者预后情况较好;预后较好组中入住ICU、意识障碍、记忆障碍患者占比低于预后不良组(P<0.05)。结论抗NMDAR脑炎患者的血清与脑脊液NMDAR水平升高,检测血清与脑脊液NMDAR水平可以有效提高诊断率与诊断的准确率,对病情诊断、预后评估具有重要的临床意义。

Objective To investigate the expression and significance of N-methyl-D-aspartate receptor(NMDAR)in 120 patients with anti-NMDAR encephalitis.Methods A total of 120 cases of patients with anti-NMDAR encephalitis enrolled in our hospital from January 2014 to June 2016 were selected as the research objects.The clinical symptoms,auxiliary examinations,treatment and prognosis of the patients were analyzed retrospectively.The expression of NMDAR in serum and cerebrospinal fluid before and after treatment were measured and analyzed.Results The main clinical symptoms of anti-NMDAR encephalitis patients were mental disorder symptom,convulsion symptom,autonomic nervous dysfunction,memory disorder,consciousness disorder,language disorder and prodromal symptoms,accounting for 92.50%,69.17%,68.33%,61.67%,58.33%,54.17%and 53.33%,respectively.After treatment,the levels of serum NMDAR and cerebrospinal fluid NMDAR were lower than those before treatment(P<0.05).After 24 months of follow-up,99 patients(82.50%)had a good prognosis;the proportions of patients with ICU admission,disturbance of consciousness and memory disorder in the better prognosis group were lower than those in the poor prognosis group(P<0.05).Conclusion The levels of serum and cerebrospinal fluid NMDAR increase in patients with anti-NMDAR encephalitis.Detection of the levels of serum and cerebrospinal fluid NMDAR can effectively improve the diagnostic rate and accuracy rate of diagnosis,which has important clinical significance for the diagnosis of disease and the evaluation of prognosis.