临床误诊误治
臨床誤診誤治
림상오진오치
CLINICAL MISDIAGNOSIS & MISTHERAPY
2015年
1期
10-12
,共3页
N-甲基天冬氨酸%抗N-甲基-D-门冬氨酸受体脑炎%误诊%脑炎,病毒性%精神病%癫痫
N-甲基天鼕氨痠%抗N-甲基-D-門鼕氨痠受體腦炎%誤診%腦炎,病毒性%精神病%癲癇
N-갑기천동안산%항N-갑기-D-문동안산수체뇌염%오진%뇌염,병독성%정신병%전간
N-methyl-D-aspartate%Anti-NMDA receptor encephalitis%Misdiagnosis%Encephalitis,viral%Mental ill-ness%Epilepsy
目的：探讨抗N-甲基-D-天冬氨酸( N-methyl-D-asparate, NMDA)受体脑炎患者发病及临床特点。方法收集北京协和医院2011年3月—2014年7月诊治的30例抗NMDA受体脑炎患者的临床资料,包括首诊临床表现、是否合并畸胎瘤、脑脊液病毒学检测及免疫学特殊抗体检测结果等,对其进行回顾性分析。结果30例早期表现无特异性,依出现频率表现为精神行为异常、癫痫发作或肢体不自主运动、发热、头痛、意识障碍,除1例首诊我院确诊外,29例曾于当地医院误诊为病毒性脑炎、精神疾病及癫痫予抗病毒治疗或联合控制癫痫治疗效果欠佳。本组均经抗NMDA受体抗体检测阳性明确诊断,初诊误诊率达100%,确诊时间(270.15±114.97) d。确诊后予糖皮质激素、丙种球蛋白及免疫抑制剂等治疗,合并畸胎瘤者予手术切除。预后与病程有一定相关性。结论临床医生应熟悉抗NMDA受体脑炎的早期常见临床表现,建议将早期抗NMDA受体抗体筛查作为高危人群鉴别诊断的常规检测项目,以提高早期诊断率,为患者赢得早期治疗时间,改善预后。
目的：探討抗N-甲基-D-天鼕氨痠( N-methyl-D-asparate, NMDA)受體腦炎患者髮病及臨床特點。方法收集北京協和醫院2011年3月—2014年7月診治的30例抗NMDA受體腦炎患者的臨床資料,包括首診臨床錶現、是否閤併畸胎瘤、腦脊液病毒學檢測及免疫學特殊抗體檢測結果等,對其進行迴顧性分析。結果30例早期錶現無特異性,依齣現頻率錶現為精神行為異常、癲癇髮作或肢體不自主運動、髮熱、頭痛、意識障礙,除1例首診我院確診外,29例曾于噹地醫院誤診為病毒性腦炎、精神疾病及癲癇予抗病毒治療或聯閤控製癲癇治療效果欠佳。本組均經抗NMDA受體抗體檢測暘性明確診斷,初診誤診率達100%,確診時間(270.15±114.97) d。確診後予糖皮質激素、丙種毬蛋白及免疫抑製劑等治療,閤併畸胎瘤者予手術切除。預後與病程有一定相關性。結論臨床醫生應熟悉抗NMDA受體腦炎的早期常見臨床錶現,建議將早期抗NMDA受體抗體篩查作為高危人群鑒彆診斷的常規檢測項目,以提高早期診斷率,為患者贏得早期治療時間,改善預後。
목적：탐토항N-갑기-D-천동안산( N-methyl-D-asparate, NMDA)수체뇌염환자발병급림상특점。방법수집북경협화의원2011년3월—2014년7월진치적30례항NMDA수체뇌염환자적림상자료,포괄수진림상표현、시부합병기태류、뇌척액병독학검측급면역학특수항체검측결과등,대기진행회고성분석。결과30례조기표현무특이성,의출현빈솔표현위정신행위이상、전간발작혹지체불자주운동、발열、두통、의식장애,제1례수진아원학진외,29례증우당지의원오진위병독성뇌염、정신질병급전간여항병독치료혹연합공제전간치료효과흠가。본조균경항NMDA수체항체검측양성명학진단,초진오진솔체100%,학진시간(270.15±114.97) d。학진후여당피질격소、병충구단백급면역억제제등치료,합병기태류자여수술절제。예후여병정유일정상관성。결론림상의생응숙실항NMDA수체뇌염적조기상견림상표현,건의장조기항NMDA수체항체사사작위고위인군감별진단적상규검측항목,이제고조기진단솔,위환자영득조기치료시간,개선예후。
Objective To investigate clinical characteristics of the resistance of N-methyl-D-aspartate ( N-methyl-D-as-parate, NMDA) receptor encephalitis patients, the cause and the key points of the differential diagnosis of viral encephalitis. Methods Clinical data of 30 cases NMDA receptor encephalitis admitted to the Hospital of Peking Union Medical College for emergency diagnosis and treatment during January 2011 and July 2014 were retrospectively analyzed, including the first clinical manifestation, whether with teratoma and other parts of the infection, cerebrospinal fluid virology and immunology specific anti-body test results. Results The early manifestations of 30 cases of early manifestations were not specific. Depending on the fre-quency, they were the frequency of mental behavior performance, seizures, or limb involuntary movement, fever, headache, consciousness. Expet 1 confirmed case by PUMC hospital, 29 cases were misdiagnosed at other local hospitals as viral encephali-tis, antiviral treatment, mental illness and epilepsy, or poor epilepsy therapy effect, or disease progression positive test of anti NMDA antibody confirmed diagnosis, and the first visit misdiagnosis rate was 100%, and the diagnosis time was (270. 15 ± 114. 97)d. Corticosteroids and gamma globulin and immunosuppressant therapy was given, and in case of merger teratoma, sur-gical resection was applied. There was a certain correlation between prognosis and progression. Conclusion Clinicians should be aware of common early clinical manifestations of NMDA receptor encephalitis, early NMDA receptor antibody screening is rec-ommended in high-risk groups for differential diagnosis as the conventional detection method in order to give early diagnosis and early treatment for patients for better prognosis.
