| 儿童抗N-甲基-D-天冬氨酸受体脑炎与重症病毒性脑炎的临床特点分析 |
| 投稿时间：2017-01-30 修订日期：2017-02-21 点此下载全文 |
| 引用本文：李丰,赵钱雷,李秀翠,李伟,胡颖,林忠东.儿童抗N-甲基-D-天冬氨酸受体脑炎与重症病毒性脑炎的临床特点分析[J].医学研究杂志,2017,46(11):165-169 |
| DOI：
10.11969/j.issn.1673-548X.2017.11.040 |
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| 中文摘要:目的 探讨儿童抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎和重症病毒性脑炎的临床特点，为两者的鉴别、早期诊断提供临床经验。方法 回顾性分析17例抗NMDAR脑炎和36例重症病毒性脑炎患儿的临床资料，比较两组的临床表现、实验室检查及影像学特点。结果 53例患儿病程中危重阶段均在PICU治疗，抗NMDAR脑炎组男性8例，女性9例，脑脊液抗NMDAR抗体全部阳性，血清抗NMDAR抗体阳性率52.9%，均未发现肿瘤。重症病毒性脑炎组患儿脑脊液HSV-Ⅰ IgM阳性率13.9%，脑脊液、血清抗NMDAR抗体均阴性。两组临床特点比较，抗NMDAR脑炎组患儿年龄偏大（P<0.01），既往可有类似病史（P<0.01），起病相对较缓（P<0.01），认知障碍不论是首发症状还是病程中都更常见（P<0.01），行为异常和睡眠障碍在病程中更常见（P<0.01），头颅MRI可表现为脑组织萎缩，而无病例发生重症病毒性脑炎（P<0.01）。重症病毒性脑炎组患儿更多伴有发热、呕吐等症状，病程中运动障碍较多见（P<0.01），且病理征阳性，脑脊液压力升高以及脑脊液蛋白增高也更常见，头颅MRI多为脑组织肿胀以及广泛信号异常。结论 儿童抗NMDAR脑炎和重症病毒性脑炎相比，患儿年龄偏大、亚急性起病、既往有类似病史、以认知障碍、行为异常和睡眠障碍为主要表现，但发热及颅高压症状相对不显著。与成人不同，儿童抗NMDAR脑炎性别差异不大，极少合并肿瘤，脑脊液中抗NMDAR抗体阳性是诊断重要依据，头颅磁共振及脑脊液检查对鉴别诊断有参考意义。 |
| 中文关键词:抗N-甲基-D-天冬氨酸受体脑炎 重症病毒性脑炎 儿童 |
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| A Clinical Study of Anti-NMDAR Encephalitis and Severe Viral Encephalitis in Children |
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| Abstract:Objective To investigate the clinical characteristics of anti-NMDAR encephalitis in children, and compared with severe viral encephalitis, therefore to improve the differential diagnosis and early diagnosis.Methods Seventeen children patients with anti-NMDAR encephalitis and thirty-six children patients with severe viral encephalitis were enrolled in the study. The clinical features, laboratory examination, neurological imaging were observed and compared between the two groups.Results All of the fifty-three patients were taken care at PICU during their severest phases. There were 8 male and 9 female in the group of patients with anti-NMDAR encephalitis. The positive rate of anti-NMDAR-antibody in cerebrospinal and serum fluid were 100% and 52.9% respectively. None of the patients were found any evidence of tumors. The positive rate of herpes simplex virus-Ⅰ IgM was 13.9% in cerebrospinal fluid in the group of patents with severe viral encephalitis. By comparing the clinical characteristics of the two groups, we found the patients with anti-NMDAR encephalitis were older (P<0.01), more common had similar past history before (P<0.01), a relatively subacute onset (P<0.01). Cognitive disorder was a more common symptom either at onset (P<0.01) or in course (P<0.01), Behavioral abnormality (P<0.01) and sleep disorders (P<0.01) in course were also more common in patients with anti-NMDAR encephalitis. MR images showed a mild degree of cerebral atrophy in some anti-NMDAR encephalitis patients, while which showed cerebral edema and extensive abnormal signals in severe viral encephalitis patients. While patents with severe viral encephalitis tended to symptoms like fever, vomiting. Motor disorders (P<0.01), pyramidal tract positive sign and increased intracranial pressure were more common.Conclusion The clinical manifestations of anti-NMDAR encephalitis and severe viral encephalitis in children are similar. The patients in school age who had symptoms of subacute onset, similar past history, cognitive disorder, behavioral abnormality and sleep disorders, without prominent fever or increased intracranial pressure, should be paid more attention to concern about anti-NMDAR encephalitis. It was different from adult that anti-NMDAR encephalitis in children was rare accompanied with tumors and male patients were not surprising. It was very helpful by testing anti-NMDAR-antibody as soon as possible for differential diagnosis between severe viral encephalitis and anti-NMDAR encephalitis in all suspicious patients. |
| keywords:Anti-NMDAR encephalitis Severe viral encephalitis Children |
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