本文選題：邊緣性腦炎 + 副腫瘤綜合征��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：本研究歸納和分析了我們科收治的11例邊緣性腦炎患者的不同發(fā)病原因、臨床表現(xiàn)，結(jié)合神經(jīng)影像學(xué)、腦電圖、腦脊液相關(guān)抗體等輔助檢查特點(diǎn)，對(duì)臨床診斷、治療、預(yù)后等問(wèn)題進(jìn)行討論，旨在提高廣大臨床醫(yī)生對(duì)邊緣性腦炎的認(rèn)知程度，及時(shí)發(fā)現(xiàn)、正確診斷，并且采取恰當(dāng)?shù)闹委煷胧苊庹`診而錯(cuò)過(guò)最佳治療時(shí)機(jī)，，以挽救或延緩患者生命。 本研究收集2012年11月至2014年3月在吉林大學(xué)第一醫(yī)院神經(jīng)內(nèi)科住院的11例邊緣性腦炎的患者的全部臨床資料，對(duì)患者的年齡、性別、起病形式、不同病因、伴隨疾病、臨床表現(xiàn)、神經(jīng)影像學(xué)檢查、腦電圖描記、相關(guān)抗體檢測(cè)、診斷與鑒別、治療及預(yù)后等相關(guān)資料進(jìn)行總結(jié)分析、評(píng)價(jià)。 11例邊緣性腦炎患者中，男性4例、女性7例。發(fā)病年齡25～75歲，平均年齡43.4歲。臨床表現(xiàn)復(fù)雜多樣：11例中有精神癥狀10例、意識(shí)障礙4例、癲癇6例、記憶障礙4例、中樞通氣不足3例、發(fā)熱3例、躁動(dòng)不安4例、口-面-舌不自主運(yùn)動(dòng)3例、肢體多動(dòng)3例、低鈉血癥4例。11例邊緣性腦炎患者腦脊液相關(guān)抗體檢測(cè)結(jié)果如下：抗Hu抗體陽(yáng)性2例，抗NMDAR抗體陽(yáng)性5例，抗LGI1抗體陽(yáng)性4例。11例患者中有肺癌1例，卵巢囊腫1例。全部患者均經(jīng)頭部MRI檢查，6例在T2WI、FLARI像上顯示一側(cè)或雙側(cè)海馬、島葉、顳葉內(nèi)側(cè)或額葉等處異常高信號(hào)。11例中1例為抗Hu抗體陽(yáng)性的肺癌患者，4例抗LGI1抗體陽(yáng)性者均未查出腫瘤，5例抗NMDAR抗體陽(yáng)性者中有1例患卵巢囊腫。11例LE患者經(jīng)長(zhǎng)程視頻腦電檢查全部異常，對(duì)于邊緣性腦炎的輔助診斷具有重要的意義。 通過(guò)分析本組11例患者的臨床特征、腦電和神經(jīng)影像學(xué)改變以及相關(guān)抗體檢測(cè)結(jié)果，使我們對(duì)邊緣性腦炎有了更加深刻的認(rèn)識(shí)和體會(huì)，現(xiàn)總結(jié)如下：(1)對(duì)于臨床上急性或亞急性發(fā)病，表現(xiàn)精神行為異常、短時(shí)記憶障礙、癲癇發(fā)作、中樞性通氣不足的患者，需要考慮邊緣性腦炎的可能。(2)當(dāng)臨床懷疑邊緣性腦炎時(shí)，尚需進(jìn)一步檢查長(zhǎng)程視頻腦電圖、頭部MRI、血和腦脊液相關(guān)免疫抗體以明確診斷。（3)若已診斷為邊緣性腦炎，當(dāng)排除感染性病因后一定還要徹底檢查究竟有無(wú)腫瘤存在，對(duì)于副腫瘤性邊緣性腦炎患者應(yīng)及時(shí)進(jìn)行腫瘤切除和聯(lián)合免疫治療。
[Abstract]:This study summarized and analyzed 11 patients with marginal encephalitis treated in our department of different causes, clinical manifestations, combined with neuroimaging, EEG, cerebrospinal fluid related antibodies and other auxiliary examination characteristics, clinical diagnosis, treatment, The purpose of the discussion on prognosis is to improve the cognition of the majority of clinicians on borderline encephalitis, to find out in time, to diagnose correctly, and to take appropriate treatment measures so as to avoid misdiagnosis and miss the best treatment opportunity. To save or delay the patient's life. From November 2012 to March 2014, we collected all clinical data of 11 patients with marginal encephalitis who were hospitalized in Department of Neurology, first Hospital of Jilin University from November 2012 to March 2014. Clinical manifestations, neuroimaging, electroencephalography, detection of relevant antibodies, diagnosis and differential diagnosis, treatment and prognosis were analyzed and evaluated. Of the 11 patients with marginal encephalitis, 4 were male and 7 were female. The onset age was 25 to 75 years, with an average age of 43.4 years. There were 10 cases of mental symptoms, 4 cases of consciousness disorder, 6 cases of epilepsy, 4 cases of memory disorder, 3 cases of central insufficiency of ventilation, 3 cases of fever, 4 cases of restlessness and 3 cases of involuntary movement of mouth, face and tongue. The results of cerebrospinal fluid (CSF) antibody detection in 3 cases of limb hyperactivity and 4 cases of hyponatremia. 11 cases of borderline encephalitis were as follows: 2 cases were positive for anti-Hu antibody, 5 cases were positive for anti NMDAR antibody, and 1 case was lung cancer in 4 cases. 11 cases were positive for anti LGI1 antibody. One case of ovarian cyst. All the patients were examined by head MRI in 6 patients with unilateral or bilateral hippocampal and insular lobes on T2WI FLARI images. Abnormal hyperintensity in medial temporal lobe or frontal lobe. One case of lung cancer with positive anti-Hu antibody was found in 1 case of ovarian cyst in 1 case of positive anti-Hu antibody in 4 cases of anti-Hu antibody positive in 4 cases and of 5 cases of positive case of anti NMDAR antibody in 1 case of ovarian cyst. 11 cases of le patients were diagnosed as having ovarian cyst. Long-range video EEG examination was all abnormal, It is of great significance for the auxiliary diagnosis of marginal encephalitis. By analyzing the clinical features, the changes of EEG and neuroimaging and the results of antibody detection in 11 patients, we have gained a deeper understanding of marginal encephalitis. The following is summarized as follows: (1) for patients with clinically acute or subacute onset, abnormal mental behavior, short-term memory disorder, epileptic seizure, or central insufficiency of ventilation, the possibility of borderline encephalitis should be considered.) when clinically suspected of marginal encephalitis, Further examination of long range video EEG, head MRI, blood and cerebrospinal fluid related immune antibodies to make a definite diagnosis of borderline encephalitis is needed. If you have diagnosed marginal encephalitis, you must thoroughly examine whether there is a tumor after you exclude the cause of infection and venereal disease. Patients with paraneoplastic marginal encephalitis should be treated with tumor resection and combined immunotherapy.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742

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