Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Neurotherapeutics. 2019 Jul;16(3):828-837. doi: 10.1007/s13311-019-00725-4.
The objective of the present study was to assess the efficacy of therapeutic plasma exchange (TPE) in patients with severe refractory anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis. Patients with severe anti-NMDA receptor encephalitis who showed no improvement after steroids and/or intravenous immunoglobulin treatment for at least 10 days were enrolled. All patients received immunotherapy and were divided into a TPE group and a non-TPE group according to treatment received. Each patient in the TPE group received at least 1 TPE course. NMDA receptor antibody titers in the cerebrospinal fluid (CSF) and plasma were evaluated within 1 week after the last TPE procedure. The clinical efficacy of treatment was evaluated after 1 month, 2 months, 3 months, 6 months, and 12 months. Forty patients were enrolled: 19 in the TPE group and 21 in the non-TPE group. Nineteen patients received TPE for a total of 118 procedures. NMDA receptor antibody titers in the CSF and/or plasma decreased or were negative after the last TPE procedure in 18 patients (94.7%). Compared with the non-TPE group, the TPE group exhibited greater clinical improvement after 1 month and 2 months following treatment (P < 0.05). After 3 months, 6 months, and 12 months, there were no significant differences in the outcomes between the TPE group and non-TPE group. The results suggest that TPE might rapidly improve the clinical manifestations in patients with severe refractory anti-NMDA receptor encephalitis, and we believe that TPE should be considered as a first-line treatment.
本研究旨在评估治疗性血浆置换（TPE）在重症难治性抗 N-甲基-D-天冬氨酸（抗 NMDA）受体脑炎患者中的疗效。纳入对类固醇和/或静脉注射免疫球蛋白治疗至少 10 天无改善的重症抗 NMDA 受体脑炎患者。所有患者均接受免疫治疗，并根据治疗方式分为 TPE 组和非 TPE 组。TPE 组患者均至少接受 1 个 TPE 疗程。在最后 1 次 TPE 操作后 1 周内评估脑脊液（CSF）和血浆中 NMDA 受体抗体滴度。在治疗后 1 个月、2 个月、3 个月、6 个月和 12 个月评估治疗的临床疗效。共纳入 40 例患者：TPE 组 19 例，非 TPE 组 21 例。19 例患者共接受 118 次 TPE。最后 1 次 TPE 后，18 例（94.7%）患者 CSF 和/或血浆中的 NMDA 受体抗体滴度降低或转为阴性。与非 TPE 组相比，TPE 组在治疗后 1 个月和 2 个月时的临床改善更明显（P<0.05）。在治疗后 3 个月、6 个月和 12 个月时，TPE 组与非 TPE 组之间的结局无显著差异。结果表明，TPE 可能迅速改善重症难治性抗 NMDA 受体脑炎患者的临床表现，我们认为 TPE 应作为一线治疗。
