5例流行性乙型脑炎儿童继发自身免疫性脑炎的临床分析

Clinical features of autoimmune encephalitis secondary to epidemic encephalitis B in 5 children

目的探讨儿童流行性乙型脑炎(epidemicencephalitisB,EEB)继发自身免疫性脑炎(autoimmune encephalitis,AE)的临床特征。方法 回顾性分析2020年1月-2022年6月在郑州大学附属儿童医院住院治疗的5例“双相病程”EEB患儿的临床资料。结果 5例患儿,男3例,女2例;中位发病年龄为7岁(范围:3岁9个月至12岁),EEB发病至AE症状出现中位间隔时间为32 (范围:25~37) d。AE期主要症状为运动障碍(5/5)、低热(4/5)、精神行为异常(4/5)、抽搐(2/5)、意识障碍加重(2/5)、肢体无力(1/5)。与EEB急性期头颅磁共振成像结果相比,AE期病灶扩大3例,无变化2例。AE期4例抗N-甲基-D-天冬氨酸受体抗体阳性,其中1例合并抗γ-氨基丁酸B型受体抗体阳性;1例AE抗体均阴性。5例患儿AE期免疫治疗均有效,随访3个月,1例基本恢复正常,4例遗留神经功能障碍。结论 EEB可诱发AE,以抗N-甲基-D-天冬氨酸受体脑炎最常见,AE期症状与经典抗N-甲基-D-天冬氨酸受体脑炎类似,免疫治疗有效,预后可能与EEB期神经功能障碍有关。

Objective To study the clinical features of children with autoimmune encephalitis(AE) secondary to epidemic encephalitis B(EEB).Methods A retrospective analysis was performed on the medical data of five children with EEB with "bipolar course" who were treated in Children’s Hospital Affiliated to Zhengzhou University from January 2020 to June 2022.Results Among the five children,there were three boys and two girls,with a median age of onset of 7 years(range 3 years 9 months to 12 years) and a median time of 32(range 25-37) days from the onset of EEB to the appearance of AE symptoms.The main symptoms in the AE stage included dyskinesia(5/5),low-grade fever(4/5),mental and behavioral disorders(4/5),convulsion(2/5),severe disturbance of consciousness(2/5),and limb weakness(1/5).Compared with the results of cranial MRI in the acute phase of EEB,the lesions were enlarged in 3 children and unchanged in 2 children showed on cranial MRI in the AE stage.In the AE stage,four children were positive for anti-Nmethyl-D-aspartate receptor antibody(one was also positive for anti-γ-aminobutyric acid type B receptor antibody),and one was negative for all AE antibodies.All five children in the AE stage responded to immunotherapy and were followed up for 3 months,among whom one almost recovered and four still had neurological dysfunction.Conclusions EEB can induce AE,with anti-N-methyl-D-aspartate receptor encephalitis as the most common disease.The symptoms in the AE stage are similar to those of classical anti-N-methyl-D-aspartate receptor encephalitis.Immunotherapy is effective for children with AE secondary to EEB,and the prognosis might be related to neurological dysfunction in the acute phase of EEB.