中西医结合治疗自身免疫性脑炎策略及应用

The strategy and experience of treating autoimmune encephalitis disease by combination of traditional Chinese and Western medicine

自身免疫性脑炎(AE)的主要临床表现为急性或亚急性的癫痫发作、精神行为异常和认知障碍。中医文献并没有AE这一病名,根据AE的分类与临床表现,符合中医“痫证”“癫疾”“狂证”“痴呆”等多种疾病范畴。文章认为“风、火、毒”为AE的诱发因素,“痰扰心神,瘀血攻心”是AE的病理基础,“肾精不足,髓海空虚”为AE的致病之源。因此,结合临床实际,总结归纳AE的中医治疗策略,初期配合西医免疫治疗当以息风、解毒、清热,中期当以息风豁痰、活血化瘀、开窍醒神,恢复期注重滋补肾精、益气养阴配合糖皮质激素减量,以期为临床治疗AE提供参考依据。

Autoimmune encephalitis(AE)is characterized by acute or subacute seizures,mental and behavioral abnormalities,and cognitive disorders.The Chinese medicine literature does not have the record of AE,according to the classification and clinical manifestations of AE,in line with the clinical manifestations of traditional Chinese medicine“epileptic madness”“maniacal-epilepsy”“epileptic madness”“maniacal-madness”and so on.It is believed that“wind,heat,poison”are the main pathogenic factors of AE,“phlegm disturbs the mind,blood stasis attacking the heart”is the pathological basis of AE,“lack of kidney essence and emptiness of the pulp sea”is the source of AE damage.Therefore,we analyzes the traditional Chinese medicine treatment of AE in combination with specific cases.In the early stage,immunotherapy combined with calm the wind,detoxification and heat.In the middle stage,the appropriate treatment is calming wind and clearing phlegm,promoting blood circulation and removing blood stasis and awakening the spirit.And in the recovery period,it is appropriate to tonifying kidney essence,invigorating qi and nourishing yin,combined with hormone reduction,supplementing positive qi to improve clinical symptoms.