摘要
目的探讨误诊为精神障碍的抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartatereceptor;NMDAR)脑炎患者的临床特征,提高早期诊断率,减少误诊。方法收集2012年至2018年在郑州大学第一附属医院确诊的抗NMDA受体脑炎患者的临床资料,筛选出误诊为精神障碍疾病的患者,回顾性分析其精神症状特征、病程特点、影像学及实验室检查结果,治疗及预后情况。结果共收集121例确诊为抗NMDA受体脑炎患者,筛选出误诊为精神障碍的43例。43例患者中,16例(37.2%)存在前驱症状,所有患者均有精神行为异常(100%),其中癫痫发作32例(74.4%)、意识水平下降13例(30.2%)、不自主运动21例(48.8%)、记忆力下降15例(34.9%)、言语功能障碍8例(18.6%)、其他神经系统症状(中枢性低通气、自主神经功能障碍)8例(18.6%),各种不同症状可能在同一患者身上同时或相继出现,症状完全缓解或只留下轻微肢体障碍者38例,遗留精神异常和癫痫发作反复入院者5例,复发率占11.6%(5/43)。结论抗NMDA受体脑炎临床表现复杂多样,多数以精神行为异常为首发症状,极易误诊为精神障碍,延迟治疗会导致病程延长,预后不良。
Objective To investigate the clinical features of patients with anti-N-methyl-Daspartate receptor(NMDAR)encephalitis misdiagnosed as mental disorder,improve the early diagnosis rate and reduce misdiagnosis.Methods The clinical data of patients with anti-NMDA receptor encephalitis diagnosed at the First Affi liated Hospital of Zhengzhou University from 2012 to 2018 were collected.Patients misdiagnosed as mental disorders were screened out.Their psychiatric symptom characteristics,disease course characteristics,imaging and laboratory fi ndings,treatment and prognosis were retrospectively analyzed.Results A total of 121 cases of anti-NMDA receptor encephalitis were collected,and 43 cases of mental disorders were screened out.Sixteen of the 43 patients(37.2%)had prodromal symptoms,and all the patients had psychiatric behavioral abnormalities(100%),including 32 cases(74.4%)of seizures,13 cases(30.2%)of decreased level of consciousness,21 cases(48.8%)of involuntary movements,15 cases(34.9%)of decreased memory,8 cases(18.6%)of speech dysfunction,and 8 cases(18.6%)of other neurological symptoms(central hyperventilation,autonomic dysfunction).Memory loss was observed in 15 cases(34.9%),speech dysfunction in 8 cases(18.6%),other neurological symptoms(central hypoventilation,autonomic dysfunction)in 8 cases(18.6%),and various symptoms may appear simultaneously or successively in the same patient.Thirty-eight cases had complete resolution of symptoms or only minor physical impairment,and 5 cases had recurrent admissions with mental abnormalities and seizures.The recurrence rate accounted for 11.6%(5/43).Conclusions The clinical manifestations of anti-NMDA receptor encephalitis are complex and varied.Most of them have mental behavior abnormalities as the fi rst symptom,which is easily misdiagnosed as mental disorder and delayed treatment will lead to prolonged disease course and poor prognosis.
作者
高艳霞
敬仰
李毅
袁丁
朱长举
王艺博
侯林林
段国宇
孙沛
王晶晶
金婉婉
徐志高
Gao Yanxia;Jing Yang;Li Yi;Yuan Ding;Zhu Changju;Wang Yibo;Hou Linlin;Duan Guoyu;SunPei;Wang Jingjing;Jin Wanwan;Xu Zhigao(Emergency Department,the First Affi liated Hospital of Zhengzhou University,Zhengzhou 450052,China;Emergency Department,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100000,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2021年第2期208-212,共5页
Chinese Journal of Emergency Medicine
基金
国家科技重大专项(2017ZX10103005-009)
国家自然科学基金青年基金项目(81701893)
河南省医学科技攻关计划省部共建项目(SB201901006)
河南省高等学校重点科研项目(20A320046)。
关键词
抗NMDA受体脑炎
免疫介导
精神障碍
首发症状
误诊
精神科
临床研究
回顾性分析
Anti-NMDA receptor encephalitis
Immune-mediated
Psychiatric disorders
First symptoms
Misdiagnosis
Psychiatry
Clinical study
Retrospective analysis
