Communicable Disease and Emergency Response Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond, CA 94804, USA.
Clin Infect Dis. 2012 Apr;54(7):899-904. doi: 10.1093/cid/cir1038. Epub 2012 Jan 26.
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.
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.
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.
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.
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。
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。
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。
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。
