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抗N-甲基-D-天冬氨酸受体脑炎病例的临床分析:中国经验

Clinical analysis on anti-N-methyl-D-aspartate receptor encephalitis cases: Chinese experience.

作者信息

Huang Xiaoqin, Fan Chunqiu, Wu Jian, Ye Jing, Zhan Shuqin, Song Haiqing, Liu Aihua, Su Yingying, Jia Jianping

机构信息

Department of Neurology, Xuan Wu Hospital, Capital Medical University 45 Changchun Street, Beijing 100053, China.

出版信息

Int J Clin Exp Med. 2015 Oct 15;8(10):18927-35. eCollection 2015.

Abstract

As a kind of autoimmune encephalitis which was just identified, the clinical manifestations of the anti-N methyl-D aspartate (anti-NMDA) receptor encephalitis are complex, diverse and in severe condition. The immunotherapy has shown good effect on the treatment but in generally, the diagnosis and treatment are still in the experience accumulation stage. More clinical research in different population is necessary, for example, in the Chinese population. This study was completed in anti-NMDA receptor encephalitis patients who were diagnosed in Beijing Xuan Wu Hospital (China) during the time from 2011 to 2013. Total 33 patients were involved with the average age of 29.7 years old when the diseases were onset. With diverse clinical manifestations, most patients displayed positively by NMDAR antibody test and 63.6% of them were associated with elevated CSF-lgA. Patients also showed abnormal MRI and EEG. Only three patients had teratomas. With hormone therapy, gamma globulin treatment or plasma exchange, more than three quarters of patients fully recovered and the others had moderate symptoms. Based on our results, we suggest that NMDAR antibody test would be helpful to make a timely diagnosis and to administer immunotherapy.

摘要

作为一种刚被确认的自身免疫性脑炎,抗N-甲基-D-天冬氨酸(抗-NMDA)受体脑炎的临床表现复杂、多样且病情严重。免疫疗法已显示出良好的治疗效果,但总体而言,诊断和治疗仍处于经验积累阶段。有必要在不同人群中开展更多临床研究,比如中国人群。本研究纳入了2011年至2013年期间在中国北京宣武医院确诊的抗-NMDA受体脑炎患者。共33例患者,发病时平均年龄为29.7岁。临床表现多样,大多数患者NMDAR抗体检测呈阳性,其中63.6%的患者脑脊液lgA升高。患者还表现出MRI和脑电图异常。仅3例患者有畸胎瘤。经过激素治疗、丙种球蛋白治疗或血浆置换,超过四分之三的患者完全康复,其他患者有中度症状。基于我们的研究结果,我们建议NMDAR抗体检测有助于及时诊断并进行免疫治疗。

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