神经元表面抗体相关脑炎5例临床分析-《福建医药杂志》

文章信息/Info

Title:: Neuronal surface antibody-associated encephalitis:clinical analysis of five cases

Keywords:: neuronal surface antibody; encephalitis; clinical manifestations; treatment

摘要:: 目的分析两种神经元表面抗体相关脑炎的临床表现、辅助检查及治疗效果,提高对本病的认识.方法对2015年6月至2016年8月在福建医科大学附属第一医院神经内科就诊的4例抗N-甲基-D-天冬氨酸(NMDA)受体脑炎和1例抗α-氨基-3-羟基-5-甲基-4-异恶唑丙酸(AMPA)2受体脑炎患者的临床表现、辅助检查、治疗方案及疗效进行回顾性分析.结果5例患者均有精神行为异常、癫痫发作、记忆障碍.4例抗NMDA受体脑炎患者脑脊液抗NMDA受体抗体3例阳性、1例未查,血清抗NMDA受体抗体3例阳性、1例可疑阳性;2例发现卵巢畸胎瘤.1例抗AMPA2受体脑炎患者脑脊液及血清抗AMPA2受体抗体均阳性.经治疗后2例基本治愈,3例明显好转.结论对新发精神行为异常伴癫痫发作、记忆障碍等疑似脑炎患者,应尽早行自身免疫性脑炎抗体检测,及时诊断和治疗以改善本病的预后.

Abstract:: Objective To summarize the clinical manifestations,auxiliary examinations and prognosis of two types of neuronal surface antibody-associated encephalitis.Methods The clinical manifestations,auxiliary examinations,treatments and therapeutic effects of four cases of anti-N-methyl-D-aspartate(NMDA) receptor encephalitis and one case of anti-α-amino-3-hydroxy-5-methlyl-4-isoxazole propionic acid(AMPA)2 receptor encephalitis collected from the First Affiliated Hospital of Fujian Medical University in June 2015 to August 2016 were retrospectively analyzed.Results Five patients all showed mental disorders,seizures,and memory impairments.In four anti-NMDA receptor encephalitis cases,the antibody in cerebrospinal fluid were positive in three cases and was without check in the other one;serum anti-NMDA receptor antibody were positive in three cases and was suspicious positive in the other one.Ovarian teratomas were found in two cases.In the anti-AMPA2 receptor encephalitis case,the antibody were positive in both cerebrospinal fluid and serum samples.Two cases were cured after treatments,and the other three cases were significantly better.Conclusion In cases of patients with mental disorders,seizures and memory disorders,autoimmune encephalitis antibodies should be tested as soon as possible,timely diagnosis and treatment will improve outcome of neuronal surface antibody-associated encephalitis.