抗N-甲基-D-天冬氨酸受体脑炎20例临床分析

摘要

目的：分析抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者临床表现、头颅MRI、脑电图（EEG）、脑脊液（CSF）特点。方法收集20例抗NMDAR脑炎患者的临床、MRI、EEG和CSF资料。结果20例抗NMDAR脑炎患者男性13例，女性7例。年龄3~61岁，平均年龄25±19岁。入院时头颅MRI异常率为60%（12/20），其中4例累及边缘系统，5例累及额顶颞枕叶、放射冠及半卵圆中心等结构。例4入院时头颅MRI检查未见异常，第24天复查见双顶枕叶、右侧胼胝体及扣带回区异常信号。16例患者行EEG检查，14例（88%）异常，异常的EEG主要为非特异性慢波，其中1例（例4）患者住院期间复查EEG出现大量δ波。90%（18/20）患者CSF结果异常；细胞学检查以淋巴细胞反应为主，例9有激活性单核细胞增多。11例（55%）患者血清和CSF NMDAR抗体阳性，7例（35%）患者仅CSF NMDAR抗体阳性，2例（例11、例14）患者仅血清NMDAR抗体阳性。结论本组以男性青少年多见。其主要临床表现为精神异常、癫痫、记忆力下降、行为异常、不自主运动等，严重者可出现中枢性低通气。头颅MRI病变不仅局限于边缘系统。重症患者EEG可出现δ波。早期诊断、治疗预后较好，部分患者可复发。%Objective To analyze the clinical manifestations,brain MRI, EEG,and cerebrospinal fluid(CSF) characteristics of the anti-N-methyl-D-aspartate receptor encephalitis.Method The clinical data, MRI,electroencephalogram(EEG) and CSF data of the 20 cases with anti-NMDAR encephalitis were collected. Results The 20 cases had been confirmed,including 13 cases of male,female 7 cases,the age range from 3 to 61 years old, median age of 25±19 years. The abnormal rate of MRI was 60% (12/20) at admission. Including 4 cases involving limbic system,5 cases involving outside structure of limbic system.The example 4 did not see abnormalities of MRI examination at admission,and on the 24th day review we could see the abnormal signal intensity area.16 patients underwent EEG examination,14 patients (88%) were abnormal,non-specific slow wave was the most common finding in abnormal EEG performance,and the large delta wave was noted in 1 patient(example 4) during the rechecking.The results of CSF were abnormal in 90% (18/20) patients.Lymphocyte reaction was the mainly finding in the cytological examination,and 1 patient had a number of activated monocytes.11 patients(55%) were found anti-NMDAR-IgG positive in both serum and CSF,7 cases (35%) of patients only CSF antibody positive and 2 patients (example 11,14) only serum IgG positive.Conclusion This group of has higher male and young patients.The major clinical manifestations includ mental disorders,epilepsy,memory decline,abnormal behavior,involuntary movements and central hypoventilation which could be found in severe cases.The brain MRI lesion is not limited to the limbic lobe.Delta wave could be noted in some severe patients when performing EEG examination.Early diagnosis and treatment are vital for prognosis , although some patients can relapse.