【作者】 黄磊；

【导师】 陈先文；

【作者基本信息】 安徽医科大学 ， 神经病学， 2015， 硕士

【摘要】 目的通过检测脑脊液中抗N-甲基-D-天冬氨酸受体(N-methyl-Daspartate receptor,NMDAR)的特异性抗体对临床拟诊的“病毒性脑炎”进行回顾性诊断及分析,并探究单纯疱疹病毒感染与NMDAR脑炎的关系。方法荧光免疫法回顾性检测2013年至2015年我科病房收治的48例临床拟诊“病毒性脑炎”患者脑脊液中NMDAR抗体,总结分析NMDAR抗体阳性患者一般临床资料、影像、电生理及实验室检查等,并采用实时荧光定量PCR技术检测NMDAR抗体阳性患者脑脊液标本中是否存在I、II型单纯疱疹病毒核酸。结果48例临床拟诊病毒性脑炎患者中10例NMDAR抗体阳性。男性6例,女性4例,年龄16-70岁。8例有发热、上呼吸道感染或腹泻等前驱感染症状。首发症状癫痫发作及精神行为异常各有4例,余2例以头痛及意识障碍为首发症状。总体临床表现与病毒性脑炎类似,主要表现有发热(8例)、头痛(5例)、意识障碍(4例)、癫痫发作(6例)、精神行为异常(7例),部分患者脑膜刺激征(3例)和病理征(3例)阳性,2例有口角及四肢不自主运动。1例头颅磁共振T2及FLAIR像可见边缘叶点片状高信号。8例脑电图不同程度异常。5例脑脊液细胞学示淋巴细胞反应。9例症状好转出院,1例症状未缓解自动出院。10例患者脑脊液I、II型单纯疱疹病毒PCR检测均为阴性结论抗NMDAR脑炎临床表现与病毒性脑炎类似,易被误诊,临床上对病因不明的脑炎及抗病毒治疗疗效不佳的疑似病毒性脑炎应行NMDAR抗体检查,以明确诊断。更多还原

【Abstract】 Objective To summarize and analyze the clinical, imaging, electroencephalogram and CSF cytology features of Anti-NMDA-receptor(NMDAR) encephalitis,and to investigate the herpes simplex virus infection in patients with NMDAR encephalitis.Methods CSF of 48 patients diagnosed as possible viral encephalitis in our department in the past 2 years were retrospectively examed for NMDAR antibody by method of fluorescence immunoassay, and the clinical data of patients with positive results of NMDAR antibody were collected and analyzed retrospectively. Fluorescent quantitative PCR technology was used for the detection of HSV I&II genotype in CSF of patients with positive NMDAR-antibody.Results Ten of 48 patients previously diagnosed as possible viral encephalitis were found to be positive in NMDAR antibody detection of CSF,with a male:female ratio of 6:4, aged 17 to 70 years. Eight cases had prodromal symptoms consisting of fever, upper respiratory-tract symptoms and diarrhea. The most common initial symptoms were psychiatric disturbance(4 cases) and epileptic seizure(4 cases), two cases started with headache and disturbance of consciousness.The general clinical features were similar to viral encephalitis, symptoms and signs consisted of fever(8 cases),headache(5 cases), disturbance of consciousness(4 cases), epileptic seizure(6 cases),psychiatric disorder(7 cases), positive meningeal irritation sign(3 cases) and pathological reflex(3 cases), involuntary movements of the limbs(2 cases).Brain MRI of 1 patient showed T2 and FLAIR signal hyperintenstity in the limbic lobe. The majority EEG tests(8 cases)were abnormal.Cerebrospinal fluid cytology showed lymphocyte reaction(5 cases). Nine patients were discharged with obviously improved, only one non-remission patientgived up on treatment. HSV I&II genotype PCR test of ten paitents with NMDAR encephalitis were all negative. Conclusion The clinical manifestations of antiNMDAR encephalitis and viral encephalitis are similar. Anti-NMDAR encephalitis should be suspected in unknown etiology of encephalitis, and NMDAR antibody detection should be performed to confirm the diagnose.更多还原