| 赵静，杨静，杨旭，王培福.抗N-甲基-D-天冬氨酸受体脑炎八例分析[J].神经损伤功能重建,2020,15(9):501-505 |
| 抗N-甲基-D-天冬氨酸受体脑炎八例分析 |
| Analysis of 8 Patients of Anti-N-Methyl-D-Aspartate Receptor Encephalitis |
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| DOI： |
| 中文关键词: 抗N-甲基-D-天冬氨酸受体脑炎 自身免疫性脑炎 精神行为异常或认知障碍 免疫治疗 |
| 英文关键词: anti-NMDAR encephalitis autoimmune encephalitis psychiatric symptoms or cognitive impairment immunotherapy |
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| 中文摘要: |
| 目的：探讨抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者的临床表现、辅助检查特点、治疗和预后。
方法：回顾性分析我院8例确诊为抗NMDAR脑炎患者的临床资料。结果：5例患者出现前驱症状；所有患者
临床症状均出现快速进展的精神行为异常、认知障碍，4例为首发症状，此外表现有言语障碍、癫痫发作、运
动障碍、意识水平下降及自主神经功能障碍等；8例患者脑脊液抗NMDAR抗体阳性，3例头MRI检查显示异
常病灶，位于大脑皮质、丘脑、海马、脑干等部位。6例患者脑电图异常，为弥漫性慢波或局灶性痫样放电。
所有患者均接受一线免疫治疗，延误诊治的1例患者对治疗反应差并出现复发。结论：抗NMDAR脑炎临床
表现复杂多样，但具有其特点，对于出现不明原因的精神行为异常或认知障碍的青年患者，及时行抗NMDAR抗体筛查十分必要，早期治疗预后良好。 |
| 英文摘要: |
| To investigate the clinical presentation, auxiliary examination, treatment, and prognosis
of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Methods: The clinical data of 8 patients with
anti-NMDAR encephalitis were retrospectively analyzed. Results: Five patients experienced a prodrome. All
patients developed rapidly progressive psychiatric symptoms or cognitive impairment, and these were the initial
symptom for 4 patients. Additional clinical manifestations included speech disorders, epileptic seizures,
movement disorders, decreased level of consciousness, and autonomic nerve dysfunction. All patients were
diagnosed by the presence of NMDAR antibodies in the cerebrospinal fluid; 3 patients presented with abnormal
lesions in brain magnetic resonance imaging (MRI) located in areas including the cerebral cortex, thalamus,
hippocampus, and brain stem. Abnormal electroencephalograms showing diffuse slow waves or focal epileptic
discharge were found in 6 patients. All patients received first-line immunotherapy, and a delayed diagnosis in 1
patient resulted in poor response to treatment and recurrence. Conclusion: The clinical manifestations of
anti-NMDAR encephalitis are complex and varied but have distinctive characteristics. For young patients with
unexplained mental/behavioral abnormalities or cognitive impairment, timely screening for anti-NMDAR
antibodies is necessary, as early treatment leads to a good outcome. |
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