Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China.
Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China.
J Healthc Eng. 2022 Mar 15;2022:4299791. doi: 10.1155/2022/4299791. eCollection 2022.
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a rare form of autoimmune encephalitis caused by anti-NMDA receptor antibodies. This disease mainly affects women of childbearing age and is commonly associated with ovarian teratoma. However, the relationship between anti-NMDA receptor encephalitis and ovarian teratoma and the role of anti-NMDA receptor antibody in the relationship remain unclear.
This study aimed to describe 15 cases of anti-NMDA receptor encephalitis (5 with ovarian teratoma), review literature, and reinforce the gynecologist's knowledge of this disorder.
Clinical data of 15 patients from January 2015 to December 2020 admitted to The Second Hospital of Hebei Medical University were collected and analyzed. The diagnosis of anti-NMDA receptor encephalitis was based on the presence of anti-NMDA receptor antibodies in cerebrospinal fluid (CSF) and/or serum. Laparoscopic teratoma removal was performed in patients with ovarian teratoma. All patients had received immunotherapy. In addition, a review of the literature was performed to reinforce the gynecologist's knowledge of this disorder.
A total of 15 patients with anti-NMDA receptor encephalitis were screened, of whom 5 patients were confirmed with ovarian teratoma by pathology. The most common symptoms of anti-NMDAR encephalitis with teratoma are fever (5/5, 100%), seizure (5/5, 100%), mental and behavioral disorders (4/5, 80%), and decreased consciousness (4/5, 80%). Conversely, the most common symptoms of patients without teratoma were neuropsychiatric symptoms, including headache (6/10, 60%) and mental and behavioral disorders (7/10, 70%). All patients underwent immunotherapy, including steroids, intravenous immunoglobulin (IVIG), plasma exchange, and cyclophosphamide, and 4 out of 5 patients with ovarian teratomas underwent surgical treatment. All patients had a good outcome after systemic, surgical, and immunotherapy treatment. No patient who underwent surgical treatment developed a recurrence. Conversely, 2 of 10 patients without teratoma developed an anti-NMDA receptor encephalitis recurrence.
Patients with anti-NMDA encephalitis show severe mental and neurological symptoms. Resection of teratoma is beneficial to the relief or disappearance of symptoms and has a good prognosis. This disorder should be fully recognized by gynecologists, who play an important role in diagnosis and treatment.
抗 N-甲基-D-天冬氨酸（NMDA）受体脑炎是一种由抗 NMDA 受体抗体引起的自身免疫性脑炎的罕见形式。这种疾病主要影响育龄妇女，常与卵巢畸胎瘤有关。然而，抗 NMDA 受体脑炎与卵巢畸胎瘤之间的关系以及抗 NMDA 受体抗体在这种关系中的作用尚不清楚。
本研究旨在描述 15 例抗 NMDA 受体脑炎（5 例伴卵巢畸胎瘤）患者的临床资料，复习文献，强化妇科医生对此类疾病的认识。
收集并分析了 2015 年 1 月至 2020 年 12 月期间河北医科大学第二医院收治的 15 例患者的临床资料。抗 NMDA 受体脑炎的诊断基于脑脊液（CSF）和/或血清中存在抗 NMDA 受体抗体。对卵巢畸胎瘤患者行腹腔镜畸胎瘤切除术。所有患者均接受免疫治疗。此外，还对文献进行了复习，以强化妇科医生对此类疾病的认识。
共筛选出 15 例抗 NMDA 受体脑炎患者，其中 5 例经病理证实伴卵巢畸胎瘤。抗 NMDA 受体脑炎伴畸胎瘤患者最常见的症状为发热（5/5，100%）、癫痫发作（5/5，100%）、精神行为障碍（4/5，80%）和意识障碍（4/5，80%）。相反，无畸胎瘤患者最常见的症状为神经精神症状，包括头痛（6/10，60%）和精神行为障碍（7/10，70%）。所有患者均接受免疫治疗，包括激素、静脉注射免疫球蛋白（IVIG）、血浆置换和环磷酰胺治疗，5 例卵巢畸胎瘤患者中有 4 例接受手术治疗。所有患者在全身、手术和免疫治疗后均取得良好结局，无手术治疗患者复发，而 10 例无畸胎瘤患者中有 2 例复发。
抗 NMDA 脑炎患者表现出严重的精神神经症状。切除畸胎瘤有利于症状的缓解或消失，且预后良好。妇科医生应充分认识到这一疾病，在诊断和治疗中发挥重要作用。
