血浆置换治疗抗N-甲基-D-天冬氨酸受体脑炎的疗效分析

Clinical efficacy of plasma exchange in N-methyl-D-aspartate receptor encephalitis children

目的分析抗N-甲基-D-天冬氨酸受体脑炎患儿开展血浆置换治疗的作用。方法选择泉州市儿童医院收治的20例抗N-甲基-D-天冬氨酸受体脑炎患儿为研究主体,研究期限是2018年7月—2021年7月。采集全部患儿临床资料,包含治疗结果、实验室指标、临床指标以及一般资料,并实施回顾性分析,依据治疗方式不同将患儿划分成常规组(10例)和试验组(10例),其中常规组患儿开展常规治疗,试验组患儿开展常规治疗以及血浆置换治疗。对比2组患儿脑脊液检查指标水平、治疗前后血清和脑脊液抗N-甲基-D-天冬氨酸抗体、治疗前后格拉斯哥昏迷评分、治疗前后康奈尔儿童谵妄评估量表(the Cornell assessment of pediatric deliriun,CAPD)得分。结果2组患儿白细胞、淋巴比例以及蛋白水平比较差异无统计学意义(P>0.05)。常规组患儿治疗前后血清以及脑脊液抗N-甲基-D-天冬氨酸抗体比较差异无统计学意义(P>0.05);试验组治疗后血清以及脑脊液抗N-甲基-D-天冬氨酸抗体水平明显低于治疗前(P<0.05)。治疗后试验组患儿格拉斯哥昏迷评分高于常规组,并且同组治疗后格拉斯哥昏迷评分均高于治疗前(P<0.05)。治疗后试验组患儿CAPD评分低于常规组,并且同组治疗后CAPD评分均低于治疗前(P<0.05)。结论抗N-甲基-D-天冬氨酸受体脑炎患儿开展血浆置换治疗,能够缓解病情,减少抗N-甲基-D-天冬氨酸抗体水平,发挥一定治疗作用。

Objective To analyze the clinical effects of plasma exchange in N-methyl-D-aspartate receptor encephalitis children.Methods 20 children with N-methyl-D-aspartate receptor encephalitis treated from July 2018 to July 2021 in Quanzhou Women's and Children's Hospital were selected as research subjects.Treatment outcomes,laboratory indicators,clinical indicators and general data were retrospectively analyzed.According to different treatment modes,children were assigned to routine group(n=10,routine therapy)and experimental group(n=10,routine therapy and plasma exchange).Cerebrospinal fluid examination indicators,serum and cerebrospinal fluid N-methyl-D-aspartate antibody,Glasgow coma scale and Cornell assessment of pediatric delirium(CAPD)scores were compared.Results The white blood cell,lymph node ratio and protein levels between groups were not significantly different(P>0.05).Before and after treatment,serum and cerebrospinal fluid N-methyl-D-aspartate antibody in the routine group were not significantly different(P>0.05).In the experimental group,serum and cerebrospinal fluid N-methyl-D-aspartate antibody after treatment were significantly lower than before(P<0.05).Glasgow coma scale scores in the experimental group were higher than routine group;Glasgow coma scale scores for two groups after treatment were higher than before(P<0.05).After treatment,CAPD scores in the experimental group were lower than routine group.CAPD scores for two groups after treatment were lower than before(P<0.05).Conclusion Plasma exchange is proven to be effective,which can reduce the children's illness state and N-methyl-D-aspartate antibody.