抗NMDA受体抗体检测在抗NMDA受体脑炎诊断中的意义

摘要

目的：总结间接免疫荧光法检测抗NMDA受体抗体阳性患者的临床特点及诊疗思路。方法回顾性分析2012年4月到2014年11月在济南军区总医院神经内科住院期间检测抗NMDA受体抗体阳性的5例患者的诊断、临床特点、治疗及预后。结果5例患者中4例临床确诊为抗NMDA受体脑炎，1例诊断为单纯疱疹病毒性脑炎（herpes simplex virus encephalitis, HSE）。5例患者发病相似，3例有明确的流感样前驱感染史，3例以精神症状首次发病，4例病情发展到一定阶段出现癫痫、呼吸衰竭入住NICU。4例抗NMDA受体脑炎患者病情后期均出现突出的运动障碍等症状。患者颅脑MRI、脑电图存在不同程度及范围异常，4例合并病毒学及免疫学指标异常。抗NMDA受体脑炎患者经激素、免疫球蛋白等治疗病情好转；HSE患者经抗病毒等治疗后病情改善。随访1年后2例抗NMDA受体脑炎患者出现肿瘤，1例死亡。结论间接免疫荧光检测抗NMDA受体抗体阳性的患者多数为抗NMDA受体脑炎，少数可为HSE等，诊断要综合患者病情及各项检查分析，防止误诊、漏诊，以正确指导治疗。%Objective To summarize and analysis the clinical features, diagnosis and treatment of the cases which were positive for anti-N-methyl-D-aspartic acid (NMDA) receptor antibodies by indirect immunofluorescence assay (IFA). Methods We analyzed the disease process, clinical characteristics, auxiliary examination , diagnosis, treat-ment, and prognosis of five cases positive for anti NMDA receptor antibodies in their serum and cerebrospinal fluid (CSF). Results Four of the five cases positive for anti-N-methyl-D-aspartic acid (NMDA) receptor antibodies were di-agnosed with anti-NMDA receptor encephalitis and one was diagnosed with Herpes Simplex Virus Encephalitis(HSE). The five cases had a similar disease presentation including prodromal flu-like symptoms in three cases and psychiatric symptoms at onset in three cases. Four cases developed epilepsy and respiratory failure during the disease course and received treatment in the NICU. Four cases had movement disorders during the late stage of isease..Electroencephalo-graphs and brain MRI showed abnormalities in most cases. The virus infection and dysimmunity test were positive in four cases. Patients with the anti-NMDA receptor encephalitis could have a good immediate prognosis after treatment with hormone and immune globulin. However, two cases developed cancer and one case died during one year fol-low-up. Conclusion Patients with HSE may also test positive for anti-NMDA receptor antibodies. Thus, diagnosis of anti-NMDA receptor encephalitis requires a thorough evaluation including patient’s history and disease course to avoid misdiagnosis.