抗 N- 甲基-D-天冬氨酸受体脑炎的妊娠结局：病例系列。
Pregnancy outcomes in anti-NMDA receptor encephalitis: Case series.
机构信息
From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2020 Jan 16;7(3). doi: 10.1212/NXI.0000000000000668. Print 2020 May.
OBJECTIVE
To report the effects of anti-NMDA receptor (NMDAR) encephalitis in pregnant patients and their babies.
METHODS
We studied a retrospective cohort of patients who developed anti-NMDAR encephalitis during pregnancy or became pregnant while recovering from the encephalitis. In addition, we reviewed the English literature between 2010 and 2019 related to this topic.
RESULTS
We studied 11 patients; 6 developed anti-NMDAR encephalitis during pregnancy, and 5 became pregnant while recovering. There were no obstetrical complications, but 6 (55%) babies were premature. Ten newborns were healthy, and 1 (9%) developed transient respiratory distress. Nine infants had assessable follow-up (median 18 months; range, 7-96 months), and all showed normal development. We identified 21 cases in the English literature. Obstetrical complications occurred in 7 (33%) pregnancies. Two patients died of septic shock (1 baby successfully delivered), another 2 had miscarriages, and in 2, the pregnancy was terminated. Sixteen babies (76%) were delivered, 9 (56%) premature. At birth, 13/16 (81%) newborns were healthy, 2/16 (13%) had transient neurologic or respiratory symptoms, and 1 (6%) died of brain edema. Follow-up (median 12 months; range, 6-36 months) was reported for 8 children: 7 (88%) showed normal development and behavior, and 1 (13%) cortical dysplasia. Immunotherapy was used during pregnancy in 7 (64%) of our patients and 18 (86%) of the reported cases, including rituximab in 4 cases, without adverse effects.
CONCLUSIONS
Patients who develop anti-NMDAR encephalitis during pregnancy or become pregnant during recovery often have obstetrical complications, but most of the newborns are healthy and appear to have normal development.
目的
报告抗 N- 甲基-D- 天冬氨酸受体（NMDAR）脑炎在孕妇及其婴儿中的影响。
方法
我们研究了一组回顾性队列患者，这些患者在怀孕期间发生抗 NMDAR 脑炎，或在脑炎康复期间怀孕。此外，我们还回顾了 2010 年至 2019 年期间与该主题相关的英文文献。
结果
我们研究了 11 例患者；6 例在怀孕期间发生抗 NMDAR 脑炎，5 例在脑炎康复期间怀孕。没有产科并发症，但 6 例（55%）婴儿早产。10 例新生儿健康，1 例（9%）出现短暂呼吸窘迫。9 例婴儿有可评估的随访（中位数 18 个月；范围，7-96 个月），均表现正常发育。我们在英文文献中发现 21 例病例。产科并发症发生在 7 例（33%）妊娠中。2 例患者死于感染性休克（1 例婴儿成功分娩），另 2 例流产，2 例终止妊娠。16 例婴儿（76%）分娩，9 例（56%）早产。出生时，16/16（81%）新生儿健康，2/16（13%）有短暂的神经或呼吸症状，1/16（6%）死于脑水肿。8 例患儿（88%）的随访（中位数 12 个月；范围，6-36 个月）结果报道正常，行为正常，1 例（13%）皮质发育不良。我们的 7 例（64%）患者和报告的 18 例（86%）患者在怀孕期间使用了免疫疗法，包括 4 例利妥昔单抗，没有不良反应。
结论
在怀孕期间发生抗 NMDAR 脑炎或在脑炎康复期间怀孕的患者常伴有产科并发症，但大多数新生儿健康，发育似乎正常。
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