摘要
目的探讨抗N-甲基-D-天冬氨酸(N-methyl-D-asparate,NMDA)受体脑炎患者发病及临床特点。方法收集北京协和医院2011年3月—2014年7月诊治的30例抗NMDA受体脑炎患者的临床资料,包括首诊临床表现、是否合并畸胎瘤、脑脊液病毒学检测及免疫学特殊抗体检测结果等,对其进行回顾性分析。结果 30例早期表现无特异性,依出现频率表现为精神行为异常、癫痫发作或肢体不自主运动、发热、头痛、意识障碍,除1例首诊我院确诊外,29例曾于当地医院误诊为病毒性脑炎、精神疾病及癫痫予抗病毒治疗或联合控制癫痫治疗效果欠佳。本组均经抗NMDA受体抗体检测阳性明确诊断,初诊误诊率达100%,确诊时间(270.15±114.97)d。确诊后予糖皮质激素、丙种球蛋白及免疫抑制剂等治疗,合并畸胎瘤者予手术切除。预后与病程有一定相关性。结论临床医生应熟悉抗NMDA受体脑炎的早期常见临床表现,建议将早期抗NMDA受体抗体筛查作为高危人群鉴别诊断的常规检测项目,以提高早期诊断率,为患者赢得早期治疗时间,改善预后。
Objective To investigate clinical characteristics of the resistance of N-methyl-D-aspartate（N-methyl-D-asparate,NMDA） receptor encephalitis patients,the cause and the key points of the differential diagnosis of viral encephalitis.Methods Clinical data of 30 cases NMDA receptor encephalitis admitted to the Hospital of Peking Union Medical College for emergency diagnosis and treatment during January 2011 and July 2014 were retrospectively analyzed,including the first clinical manifestation,whether with teratoma and other parts of the infection,cerebrospinal fluid virology and immunology specific antibody test results. Results The early manifestations of 30 cases of early manifestations were not specific. Depending on the frequency,they were the frequency of mental behavior performance,seizures,or limb involuntary movement,fever,headache,consciousness. Expet 1 confirmed case by PUMC hospital,29 cases were misdiagnosed at other local hospitals as viral encephalitis,antiviral treatment,mental illness and epilepsy,or poor epilepsy therapy effect,or disease progression positive test of anti NMDA antibody confirmed diagnosis,and the first visit misdiagnosis rate was 100%,and the diagnosis time was（270. 15 ±114. 97） d. Corticosteroids and gamma globulin and immunosuppressant therapy was given,and in case of merger teratoma,surgical resection was applied. There was a certain correlation between prognosis and progression. Conclusion Clinicians should be aware of common early clinical manifestations of NMDA receptor encephalitis,early NMDA receptor antibody screening is recommended in high-risk groups for differential diagnosis as the conventional detection method in order to give early diagnosis and early treatment for patients for better prognosis.
出处
《临床误诊误治》
2015年第1期10-12,共3页
Clinical Misdiagnosis & Mistherapy
