儿童精神障碍行自身免疫性脑炎筛查结果分析

Analysis of screening results for autoimmune encephalitis in children with mental disorders

目的探析筛查确诊为自身免疫性脑炎(AE)的儿童精神障碍(MD)的临床和主要辅助检查之特点,提高临床医生对AE所致儿童MD的早期识别。方法回顾性分析2016年1月至2020年1月在深圳市儿童医院神经内科住院治疗的56例MD患儿AE筛查结果,筛查阳性病例定为AE组,阴性病例归为非AE组,统计AE组患儿MD的类型并比较两组患儿的脑电图(EEG)、颅脑MRI的差异。结果56例MD患儿中有11例确诊为AE,占19.6%,且均为抗N-甲基-D天门冬氨酸受体(NMDAR)脑炎,其中抑郁症7例、焦虑症3例、精神分裂症1例;男性6例,女性5例;AE组患儿的EEG出现慢波增多、背景慢、癫痫样波等异常表现明显多于非AE组,差异均有统计学意义(P<0.05),但两组患儿的颅脑MRI表现比较差异无统计学意义(P>0.05)。结论儿童MD因AE所致并不少见,且多为AE中的抗NMDAR脑炎。EEG异常的MD患儿为AE所致可能性大,而伴有EEG异常的抑郁症、焦虑症的患儿可能性更大。

Objective To analyze the clinical features and main auxiliary examinations of children with mental disorders(MD)diagnosed as autoimmune encephalitis(AE),so as to improve the early recognition of MD caused by AE by clinicians.Methods Retrospective analysis was performed on the screening results for 56 children with mental disorders hospitalized in Shenzhen Children's Hospital from January 2016 to January 2020.The positive cases were enrolled as AE group,and the negative cases as the AE group.The types of mental disorders in AE group were collected,and the differences between two groups of electroencephalogram(EEG)and brain MRI were compared.Results Among the 56 cases,11 cases were diagnosed with AE,accounting for 19.6%,and all of them were anti-N-methyl D-aspartate(NMDA)receptor(anti-NMDAR)encephalitis,including 7 cases of depression,3 cases of anxiety,1 case of schizophrenia,6 cases of males and 5 of females.The abnormal manifestations of slow wave,slow background and epileptic wave in EEG of the AE group were significantly more than those in the non-AE group,with statistically significant differences(P<0.05),but there was no significant difference in brain MRI between the two groups(P>0.05).Conclusion AE-caused MD in children is not uncommon,and most of them are anti-NMDAR encephalitis in AE.Children with MD with abnormal EEG were more likely to be caused by AE,especially children with depression and anxiety with abnormal EEG.