中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2015年
6期
637-641
,共5页
黄曜纬%颜振兴%贺荣霓%谢惠芳
黃曜緯%顏振興%賀榮霓%謝惠芳
황요위%안진흥%하영예%사혜방
受体%抗N-甲基-D-天冬氨酸%脑炎%自身免疫疾病
受體%抗N-甲基-D-天鼕氨痠%腦炎%自身免疫疾病
수체%항N-갑기-D-천동안산%뇌염%자신면역질병
Receptor%Anti-N-methyl-D-aspartic acid%Encephalitis%Autoimmune disease
目的 分析抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的临床特点、实验室检查结果及诊断治疗方法与预后. 方法 收集自南方医科大学珠江医院神经内科自2012年2月至2014年11月收治的3例NMDAR脑炎患者的临床资料,回顾性分析其临床症状特点、实验室检查、治疗及预后. 结果 3例患者临床以发热、精神行为异常、抽搐、口面部不自主运动、自主神经功能紊乱为主要特征,其中1例伴有卵巢未成熟型畸胎瘤,l例伴有纵膈成熟型畸胎瘤,2例血及脑脊液抗NMDAR抗体阳性,不伴肿瘤l例患者脑脊液抗NMDAR抗体阳性,血清抗NMDAR抗体阴性,3例患者脑电图均有异常,其中2例头颅MR异常,早期免疫治疗及肿瘤切除有效. 结论 NMDAR脑炎患者有其较特征性临床表现,脑脊液及血清中抗NMDAR抗体检测有助于抗NMDAR脑炎患者的早期诊断,早期行免疫治疗及肿瘤切除治疗有效.
目的 分析抗N-甲基-D-天鼕氨痠受體(NMDAR)腦炎的臨床特點、實驗室檢查結果及診斷治療方法與預後. 方法 收集自南方醫科大學珠江醫院神經內科自2012年2月至2014年11月收治的3例NMDAR腦炎患者的臨床資料,迴顧性分析其臨床癥狀特點、實驗室檢查、治療及預後. 結果 3例患者臨床以髮熱、精神行為異常、抽搐、口麵部不自主運動、自主神經功能紊亂為主要特徵,其中1例伴有卵巢未成熟型畸胎瘤,l例伴有縱膈成熟型畸胎瘤,2例血及腦脊液抗NMDAR抗體暘性,不伴腫瘤l例患者腦脊液抗NMDAR抗體暘性,血清抗NMDAR抗體陰性,3例患者腦電圖均有異常,其中2例頭顱MR異常,早期免疫治療及腫瘤切除有效. 結論 NMDAR腦炎患者有其較特徵性臨床錶現,腦脊液及血清中抗NMDAR抗體檢測有助于抗NMDAR腦炎患者的早期診斷,早期行免疫治療及腫瘤切除治療有效.
목적 분석항N-갑기-D-천동안산수체(NMDAR)뇌염적림상특점、실험실검사결과급진단치료방법여예후. 방법 수집자남방의과대학주강의원신경내과자2012년2월지2014년11월수치적3례NMDAR뇌염환자적림상자료,회고성분석기림상증상특점、실험실검사、치료급예후. 결과 3례환자림상이발열、정신행위이상、추휵、구면부불자주운동、자주신경공능문란위주요특정,기중1례반유란소미성숙형기태류,l례반유종격성숙형기태류,2례혈급뇌척액항NMDAR항체양성,불반종류l례환자뇌척액항NMDAR항체양성,혈청항NMDAR항체음성,3례환자뇌전도균유이상,기중2례두로MR이상,조기면역치료급종류절제유효. 결론 NMDAR뇌염환자유기교특정성림상표현,뇌척액급혈청중항NMDAR항체검측유조우항NMDAR뇌염환자적조기진단,조기행면역치료급종류절제치료유효.
Objective To explore the clinical features,laboratory test results,diagnosis,treatment and prognosis of patients with anti-N-methyl-D-aspartic acid receptor (NMDAR) encephalitis.Methods A retrospectives analysis of clinical characteristics,laboratory test,treatment and prognosis of 3 patients with NMDRA encephalitis,admitted to our hospital from February 2012 to November 2014,was performed in our study.Results The most predominant symptoms of 3 patients with anti-NMDAR encephalitis included fever,psychiatric behavioral disturbances,seizures,orofacial dyskinesias and movement disorders and autonomic dysfunction.One patient had immature ovarian teratoma and one had mature mediastinal teratoma.Anti-NMDAR antibody was positive in serum and cerebrospinal fluid of two patients with teratoma,and anti-NMDAR antibody was positive in cerebrospinal fluid and negative in serum of one patient without tumour;all three patients showed abnormal electroencephalography,and 2 had increased signal on MR imaging T2 sequences or fluid-attenuated inversion.Patients were responsive to early immunotherapy and tumour resection.Conclusion The patient with NMDAR encephalitis presented with characteristic clinical manifestations;detection of anti-NMDAR antibody in serum and cerebrospinal fluid may be important for early diagnosis;early immunotherapy and tumour resection are effective for patients with NMDAR encephalitis.
