Shi Yan-Chao, Chen Xiu-Ju, Zhang Hong-Mei, Wang Zhen, Du Da-Yong
Department of Neurology, Tianjin Port Hospital, Tianjin, China.
Department of Neurology, Tianjin Nankai Hospital, Tianjin, China.
Taiwan J Obstet Gynecol. 2017 Jun;56(3):315-319. doi: 10.1016/j.tjog.2017.04.009.
To analyze the clinical features of 13 pregnant patients with anti-N-Methyl-d-Aspartate receptor (NMDAR) encephalitis.
Retrospective review of thirteen reported cases was conducted for anti-NMDAR encephalitis patients during pregnancy. The clinical data were collected from papers published in PubMed prior to 16 February 2016. Statistical analysis of the data was performed, which encompasses the patients' age, past medical history, onset of symptoms, concomitant with ovarian teratomas, immunotherapy, outcomes of mothers and newborns.
Thirteen cases were reported in 11 articles with a median age of 23 (interquartile range, 19-27) years old. There were eight cases in which the onset periods of gestation happened in the first trimester and five cases in the second trimester. Among 13 cases, five patients had a past medical history, one concomitant with autoimmune Graves' hyperthyroidism, one with bilateral ovarian teratomas removed history, one with anti-NMDAR encephalitis five years before pregnancy and two with psychiatric symptoms. Five patients were found with ovarian teratomas. Seven patients responded to first-line immunotherapy whereas all of two patients responded to second-line immunotherapy when the first-line immunotherapy failed. Following up all the 13 patients, most experienced a substantial recovery, except one had spasticity and dystonia in one hand, and one died of a superimposed infection. Three fetuses were miscarried or aborted in total. Most newborns were healthy, except two cases (2/10) with abnormal neurologic signs.
Clinical analysis of the data indicates that most patients respond to first-line immunotherapy. A second-line immunotherapy is effective when first-line immunotherapy fails. It has also been found that most mothers and newborns can have good outcomes.
分析13例抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎孕妇的临床特征。
对13例已报道的妊娠期间抗NMDAR脑炎患者进行回顾性研究。临床数据收集自2016年2月16日前发表于PubMed上的论文。对数据进行统计分析，包括患者年龄、既往病史、症状发作情况、是否合并卵巢畸胎瘤、免疫治疗情况、母亲及新生儿结局。
11篇文章报道了13例病例，中位年龄为23岁（四分位间距，19 - 27岁）。其中8例妊娠发作期发生在孕早期，5例发生在孕中期。13例患者中，5例有既往病史，1例合并自身免疫性格雷夫斯甲亢，1例有双侧卵巢畸胎瘤切除史，1例在妊娠前5年患抗NMDAR脑炎，2例有精神症状。5例患者发现有卵巢畸胎瘤。7例患者对一线免疫治疗有反应，2例一线免疫治疗失败后对二线免疫治疗均有反应。对13例患者进行随访，大多数患者有显著恢复，除1例有一只手出现痉挛和肌张力障碍，1例死于叠加感染。共有3例胎儿流产或早产。大多数新生儿健康，除2例（2/10）有神经系统异常体征。
数据的临床分析表明，大多数患者对一线免疫治疗有反应。一线免疫治疗失败时二线免疫治疗有效。还发现大多数母亲和新生儿预后良好。
