摘要
目的 分析儿童单病程及复发性抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎的临床特征和预后。方法 选取2013年1月至2020年12月在首都儿科研究所附属儿童医院神经内科治疗的抗NMDAR脑炎患儿63例,回顾性分析其中复发(在随访过程中出现≥2次的脑炎表现的病情反复)和无复发(单病程)患儿的临床特征、诊疗情况和预后。结果 随访1~8年,其中复发患儿9例(14.3%),男6例,女3例;初发年龄6.9~13.1岁,平均(9.79±1.68)岁;复发的时间为5~63个月,平均(24.89±17.62)个月。2例(22.2%)患儿≥2次复发。复发患儿初次发病症状最常见的依次为言语障碍8例(88.9%),精神行为异常7例(77.8%),癫痫发作6例(66.7%),不自主运动6例(66.7%)。复发时患儿改良Rankin评分为(2.22±1.10)分,低于初次发病时评分[(3.77±1.12)分],差异有显著性(P<0.05)。4例(44.4%)患儿初次发作时头颅MRI存在异常。6例(66.7%)患儿初次发病时存在脑脊液白细胞升高。所有复发患儿均未发现肿瘤。单因素分析显示,年龄、脑脊液抗NMDAR抗体滴度≥1∶100、转入ICU治疗与儿童抗NMDAR脑炎复发有关(P<0.05)。多因素logistic回归分析显示,转入ICU治疗是儿童抗NMDAR脑炎复发的独立危险因素(P<0.05)。6例(66.7%)复发患儿进行了脑脊液病原学宏基因检测,未发现病原学证据。结论 抗NMDAR脑炎复发患儿的发病年龄偏大,病情严重患儿容易复发。复发较初次发病症状有所减轻。
Objective To analyze the clinical characteristics and prognosis of single course and recurrent anti N-methyl-D-aspartate receptor(NMDAR)encephalitis in children.Method A retrospective study was conducted on children with anti NMDAR encephalitis admitted to the Neurology Department of the Children’s Hospital Affiliated to the Capital Institute of Pediatrics from January 2013 to December 2020.The clinical characteristics,diagnosis and treatment status,and prognosis of single course and recurrent children were analyzed.Result Follow up the children with anti NMDAR encephalitis for 1-8 years,among them,9(14.3%)had relapses,including 6 males and 3 females.The initial onset age is 6.9 to 13.1 years old,with an average age of(9.79±1.68)years old.The recurrence time is 5-63 months,with an average of(24.89±17.62)months.Two patients(22.2%)had≥2 relapses.The most symptoms of initial onset in the recurrent group were speech disorders in 8 cases(88.9%),abnormal mental behavior in 7 cases(77.8%),seizures in 6 cases(66.7%),and involuntary movements in 6 cases(66.7%).At the initial onset,the average mRS score was 3.77±1.12,and at the recurrence stage,the average mRS score was 2.22±1.10,with a statistically significant difference(P<0.05).4 cases(44.4%)had abnormal cranial magnetic resonance imaging at the initial onset.6 cases(66.7%)had elevated white blood cells in cerebrospinal fluid at the initial onset of the disease.No tumors were found in all recurrent children.Univariate analysis showed that age,cerebrospinal fluid anti NMDAR antibody titer≥1:100,and referral to ICU treatment were associated with the recurrence of anti NMDAR encephalitis in children(P<0.05).Multivariate logistic regression analysis showed that transferring to ICU treatment was an independent risk factor for the recurrence of anti NMDAR encephalitis in children(P<0.05).6 cases(66.7%)with recurrent anti NMDAR encephalitis underwent cerebrospinal fluid pathogen macro gene testing,and no pathogenic evidence was found.Conclusion The age distribution o
作者
张建昭
孙静
郑萍
李冠男
任海涛
陈倩
Zhang Jianzhao;Sun Jing;Zheng Ping;Li Guannan;Ren Haitao;Chen Qian(Department of Pediatric Neurology,Children’s Hospital Affiliated to the Capital Institute of Pediatrics,Beijing 100020,China;Peking Union Medical College Hospital,Chinese Academy of Medical Science,Beijing 100010,China)
出处
《中国医刊》
CAS
2023年第6期648-651,共4页
Chinese Journal of Medicine
