单纯疱疹病毒脑炎继发抗N-甲基-D-天冬氨酸受体脑炎患儿3例临床分析

Herpes simplex virus encephalitis-induced anti-N-methyl-D-aspartate receptor encephalitis in children:a clinical analysis of 3 cases

目的分析儿童单纯疱疹病毒脑炎继发抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的临床特点、治疗及转归情况。方法收集我科收治的3例单纯疱疹病毒脑炎继发抗NMDAR脑炎患儿临床资料,其中男2例、女1例,年龄分别为1岁9个月、10岁和4岁。结果3例患儿均表现为抽搐起病,伴意识改变、行为异常,脑脊液单纯疱疹病毒Ⅰ型均为阳性。3例患儿予抗病毒及对症处理后病情均有好转,但分别于病程1周至1个月后病情再次加重,脑脊液NMDAR抗体均呈阳性。经积极对症治疗后,2例患儿恢复较好,1例放弃治疗后死亡。结论单纯疱疹病毒脑炎可发展至抗NMDAR脑炎,动态检测NMDAR抗体有助于早期识别单纯疱疹病毒脑炎后自身免疫性脑炎的发生,从而进行早期干预。

Objective To investigate the clinical characteristics,treatment and outcomes of herpes simplex virus encephalitis-induced anti-N-methyl-D-aspartate receptor(anti-NMDAR)encephalitis in children.Methods The clinical data of 3 children with herpes simplex virus encephalitis-induced anti-NMDAR encephalitis treated in our department were collected,including 2 males and 1 female,aged 21 months,10 years and 4 years,respectively.Results All the 3 children began with convulsion,accompanied by altered consciousness and abnormal behavior.Herpes simplex virus typeⅠin cerebrospinal fluid was tested positive in all 3 cases.After antiviral and symptomatic treatment,the condition of 3 children was improved,but was aggravated again after 1 week to 1 month,with positive cerebrospinal fluid anti-NMDAR antibodies.After active symptomatic treatment,2 children recovered well,and 1 gave up treatment and died.Conclusion Herpes simplex virus encephalitis can develop anti-NMDAR encephalitis.Dynamic detection of anti-NMDAR antibody is helpful to early identify the occurrence of autoimmune encephalitis after herpes simplex virus encephalitis,so as to intervene early.