在加利福尼亚脑炎项目中纳入的年轻人中，自身免疫性 N-甲基-D-天冬氨酸受体脑炎的频率超过了单一病毒病因的频率。
The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project.
机构信息
Communicable Disease and Emergency Response Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond, CA 94804, USA.
出版信息
Clin Infect Dis. 2012 Apr;54(7):899-904. doi: 10.1093/cid/cir1038. Epub 2012 Jan 26.
BACKGROUND
In 2007, the California Encephalitis Project (CEP), which was established to study the epidemiology of encephalitis, began identifying cases of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Increasing numbers of anti-NMDAR encephalitis cases have been identified at the CEP, and this form rivals commonly known viral etiologies as a causal agent. We report here the relative frequency and differences among encephalitides caused by anti-NMDAR and viral etiologies within the CEP experience.
METHODS
Demographic, frequency, and clinical data from patients with anti-NMDAR encephalitis are compared with those with viral encephalitic agents: enterovirus, herpes simplex virus type 1 (HSV-1), varicella-zoster virus (VZV), and West Nile virus (WNV). All examined cases presented to the CEP between September 2007 and February 2011 and are limited to individuals aged ≤30 years because of the predominance of anti-NMDAR encephalitis in this group. The diagnostic costs incurred in a single case are also included.
RESULTS
Anti-NMDAR encephalitis was identified >4 times as frequently as HSV-1, WNV, or VZV and was the leading entity identified in our cohort. We found that 65% of anti-NMDAR encephalitis occurred in patients aged ≤18 years. This disorder demonstrated a predilection, which was not observed with viral etiologies, for females (P < .01). Seizures, language dysfunction, psychosis, and electroencephalographic abnormalities were significantly more frequent in patients with anti-NMDAR encephalitis (P < .05), and autonomic instability occurred exclusively in this group.
DISCUSSION
Anti-NMDAR encephalitis rivals viral etiologies as a cause of encephalitis within the CEP cohort. This entity deserves a prominent place on the encephalitic differential diagnosis to avoid unnecessary diagnostic and treatment costs, and to permit a more timely treatment.
背景
2007 年，为研究脑炎的流行病学而成立的加州脑炎项目（CEP）开始确定抗 N-甲基-D-天冬氨酸受体（抗 NMDAR）脑炎病例。在 CEP 中已确定越来越多的抗 NMDAR 脑炎病例，这种形式与常见的已知病毒病因一样成为病因。我们在此报告 CEP 经验中抗 NMDAR 和病毒病因引起的脑炎的相对频率和差异。
方法
将抗 NMDAR 脑炎患者的人口统计学、频率和临床数据与病毒脑炎病原体（肠道病毒、单纯疱疹病毒 1 型（HSV-1）、水痘带状疱疹病毒（VZV）和西尼罗河病毒（WNV））进行比较。所有检查病例均于 2007 年 9 月至 2011 年 2 月期间在 CEP 就诊，由于抗 NMDAR 脑炎在该组中占主导地位，因此仅限于年龄≤30 岁的个体。还包括在单个病例中产生的诊断费用。
结果
抗 NMDAR 脑炎的发病率是 HSV-1、WNV 或 VZV 的 4 倍以上，是我们队列中确定的主要病原体。我们发现，65%的抗 NMDAR 脑炎发生在年龄≤18 岁的患者中。这种疾病表现出一种倾向，而病毒病因则没有这种倾向，即女性发病率更高（P<.01）。与病毒病因相比，抗 NMDAR 脑炎患者更常出现癫痫发作、语言功能障碍、精神病和脑电图异常（P<.05），而自主神经不稳定仅发生在该组。
讨论
抗 NMDAR 脑炎在 CEP 队列中与病毒病因一样是脑炎的病因。在脑炎的鉴别诊断中，这种疾病应占据突出地位，以避免不必要的诊断和治疗费用，并允许更及时的治疗。
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