本文關(guān)鍵詞： N-甲基-D-天冬氨酸受體(NMDA受體) 抗N-甲基-D-天冬氨酸受體腦炎(抗NMDA受體腦炎) 自身免疫性腦炎 中國人群　出處：《浙江大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：目的： 自2007年N-甲基-D-天冬氨酸受體(N-Methyl-D-Aspartate Receptor, NMDAR)抗體發(fā)現(xiàn)以來,歐美國家已展開了大規(guī)模的臨床觀察研究。但自從2010年我國第一例病例報道以來,國內(nèi)尚無大規(guī)模的臨床研究,中國人群抗NMDA受體腦炎的臨床特征尚不清晰。本研究通過總結(jié)本院的抗NMDA受體腦炎患者的病例特征,并結(jié)合文獻(xiàn)回顧中報道的病例,分析中國人群抗NMDA受體腦炎的患者一般情況、臨床表現(xiàn)、輔助檢查及治療預(yù)后的臨床特征及影響因素。 方法： 本研究納入自2012年1月至2015年3月,就診于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院的抗NMDA受體腦炎患者,收集性別、年齡、臨床表現(xiàn)、輔助檢查結(jié)果、治療方案及預(yù)后相關(guān)資料。同時,搜索維普、萬方、中國知網(wǎng)及pubmed、Cochrane、 Web of Science中報道中國患者的文獻(xiàn),提取相應(yīng)臨床資料。分別統(tǒng)計我院及文獻(xiàn)回顧中的患者臨床特征,并將二者合并后分析影響各臨床特征的因素。 結(jié)果： 抗NMDA受體腦炎好發(fā)于青年女性。約49%患者在發(fā)病前有前驅(qū)癥狀。大部分人以精神癥狀起病。幾乎所有的患者均有精神癥狀,約60%的患者有運(yùn)動障礙和(或)癇樣發(fā)作。約38%的患者會出現(xiàn)自主神經(jīng)功能障礙。輔助檢查結(jié)果缺乏特異性,大多數(shù)患者的腦脊液壓力、有核細(xì)胞、蛋白、糖、氯化物正�；蜉p度升高。絕大多數(shù)(85%)患者腦電圖存在異常,以慢波增多為主要表現(xiàn)。約50%患者有磁共振檢查異常信號,FLAIR序列可能有更高的陽性率。大多數(shù)(79%)患者腦脊液和血液中抗體滴度基本相同,約20%的患者血液中抗體滴度偏低,腦脊液檢查有異常表現(xiàn)者血液中抗體滴度偏低風(fēng)險較高(p=0.021)。約20%的患者合并腫瘤,女性發(fā)生率高于男性(p=0.04)。女性好發(fā)畸胎瘤,而男性則為肺癌。研究中涉及的治療方案有四種,即單純丙種球蛋白、單純激素、丙種球蛋白聯(lián)合激素和手術(shù)聯(lián)合免疫抑制治療。其中,單純使用丙種球蛋白的治療效果弱于其他三種(p0.001),而是否發(fā)生中樞性低通氣則是影響預(yù)后的重要因素(p=0.01)。 結(jié)論： 本研究通過回顧我院病例和中國人群的病例報告,總結(jié)了抗NMDA受體腦炎的臨床特征及可能影響臨床表現(xiàn)的因素,為臨床實踐提供了循證醫(yī)學(xué)支持。
[Abstract]:Objective: Since the discovery of N-Methyl-D-Aspartate Receptor- (NMDAR) antibody against N-methyl-Daspartic acid receptor (NMDAR) in 2007. Large scale clinical observation studies have been carried out in Europe and America. However, since 2010, there has been no large-scale clinical study in China since the first case was reported in China. The clinical characteristics of anti NMDA receptor encephalitis in Chinese population are not clear. This study summarized the case characteristics of anti NMDA receptor encephalitis in our hospital and combined with the cases reported in literature review. To analyze the general situation, clinical manifestation, adjuvant examination and prognosis of patients with NMDA receptor encephalitis in Chinese population. Methods: From January 2012 to March 2015, this study included patients with anti NMDA receptor encephalitis who were admitted to the second affiliated Hospital of Zhejiang University School of Medicine to collect gender, age and clinical manifestations. Results of adjuvant examination, treatment plan and prognosis. Meanwhile, search for Weip, Wanfang, ChinaNet and pubmedan Cochrane. The Web of Science reports the Chinese patients' literature, extracts the corresponding clinical data, and counts the clinical characteristics of the patients in our hospital and literature review. The factors influencing the clinical characteristics were analyzed after combining the two methods. Results: Anti NMDA receptor encephalitis occurs in young women. About 49% patients have precursor symptoms before onset. Most of them start with mental symptoms. Almost all patients have mental symptoms. About 60% of the patients had dyskinesia and / or epileptiform seizures. About 38% of the patients had autonomic nervous dysfunction. The results of the adjuvant tests were unspecific and most patients had cerebrospinal fluid pressure and nucleated cells. Protein, sugar and chloride were normal or slightly elevated. Most of the patients had abnormal EEG, with the increase of slow wave as the main manifestation. About 50% patients had abnormal signal of magnetic resonance examination. FLAIR sequence may have higher positive rate. Most of the patients have the same titer of antibodies in cerebrospinal fluid and blood, and about 20% patients have lower titer of antibodies in blood. Patients with abnormal cerebrospinal fluid examination had a higher risk of low titer of antibodies in their blood. About 20% of the patients were complicated with tumor. The incidence of teratoma in women is higher than that in men. The incidence of teratoma in women is higher than that in men. Gamma globulin combined with hormone and surgery combined with immunosuppressive therapy. The effect of using gamma globulin alone was weaker than that of the other three groups (P 0.001). The occurrence of central hypopnea is an important factor affecting prognosis. Conclusion: In this study, the clinical characteristics of anti NMDA receptor encephalitis and the factors that may affect its clinical manifestation were summarized by reviewing the case reports of our hospital and Chinese population, which provided evidence based medicine support for clinical practice.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R747.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 鐘建民;;兒童抗N-甲基-D-天門冬氨酸受體腦炎的治療[J];中國當(dāng)代兒科雜志;2014年06期

2 滕麗華;王仲;;抗NMDA受體腦炎30例誤診分析[J];臨床誤診誤治;2015年01期

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本文編號：1473619