本文選題：抗NMDAR腦炎 + 臨床特點(diǎn)��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分析抗NMDAR腦炎在兒童和成人的臨床表現(xiàn)、輔助檢查、治療方案、預(yù)后,重點(diǎn)比較兒童和成人抗NMDAR腦炎在臨床表現(xiàn)、預(yù)后的差異,以加深對抗NMDAR腦炎的了解。方法:收集2014年01月至2017年3月于廣西醫(yī)科大學(xué)第一附屬醫(yī)院及第二附屬醫(yī)院神經(jīng)內(nèi)科、兒科住院診斷為抗NMDAR腦炎60例患者納入本研究。并且對符合納入標(biāo)準(zhǔn)的60例患者進(jìn)行回顧性分析,收集其人口學(xué)資料、病史、臨床表現(xiàn)、實驗室檢查、影像學(xué)檢查及治療效果等資料。將年齡≤14歲歸為兒童組,年齡14歲為成人組,分別總結(jié)兩組病人的臨床特點(diǎn)及比較兒童、成人在臨床表現(xiàn)及預(yù)后方面的差異。結(jié)果:⑴基本情況:60例抗NMDAR腦炎患者,其中男性31例,女性29例,男:女=6:5。其中成人組28例,兒童組32例,年齡區(qū)間為3-51歲,兒童組平均發(fā)病年齡為7.8±3.3歲,成人組平均發(fā)病年齡28.4±12.0歲。⑵前驅(qū)癥狀發(fā)生率:兒童組13例(40.6%),成人組13例(46.4%)。(3)首發(fā)癥狀以精神行為異常為首發(fā)癥狀:兒童組14例(43.8%)、成人組8例(28.6%);癲癇發(fā)作:兒童組7例(21.9%)、成人組7例(25%);精神行為異常+癲癇發(fā)作:兒童組6例(18.8%)、成人組7例(25%)。另外兒童組中3例(9.4%)以肢體無力為首發(fā)癥狀;成人組中記憶力、計算力下降3例(10.7%),雙下肢乏力并行走不穩(wěn)2例(7.1%)。以精神行為異常、癲癇發(fā)作、精神行為異常+癲癇發(fā)作為首發(fā)癥狀的抗NMDAR腦炎患者在兒童構(gòu)成比與成年人構(gòu)成比及男性構(gòu)成比與女性構(gòu)成比差異無統(tǒng)計學(xué)意義(P0.05)。⑶臨床表現(xiàn)癲癇發(fā)作:兒童組23例(占71.8%)、成人組26例(92.9%);認(rèn)知功能障礙:兒童組29例(90.6%)、成人組24例(85.7%);精神行為異常:兒童組中所有患兒均出現(xiàn)了不同類型的精神異常32例(100%)、成人組23例(占82.1%);中樞性低通氣:兒童組3例(9.4%)、成人組21例(75%);運(yùn)動障礙:兒童組27例(84.3%)、成人組20例(71.4%);自主神經(jīng)功能障礙:兒童組20例(62.5%)、成人組20例(71.4%);意識障礙:兒童組16例(50%)、成人組14例(50%);疾病復(fù)發(fā):兒童組12例(37.5%)、成人組2例(7.1%)。另外,兒童組中有30例(占93.7%)出現(xiàn)語言障礙、19例(59.3%)出現(xiàn)睡眠障礙;癲癇發(fā)作、精神異常、中樞性低通氣、復(fù)發(fā)癥狀在兒童與成年人中發(fā)生概率比較,p0.05,差異有統(tǒng)計學(xué)意義。認(rèn)知功能障礙、運(yùn)動功能障礙、神經(jīng)功能障礙、意識障礙臨床表現(xiàn)在兒童與成年人中發(fā)生概率的比較,p0.05,差異無統(tǒng)計學(xué)意義。⑷輔助檢查(1)腦脊液壓力:兒童組腦脊液壓力均正常,成人組中有8例升高(28.6%)。腦脊液常規(guī)、生化:兒童組異常6例、有核細(xì)胞數(shù)增多6例(18.8%)、蛋白升高1例(3.12%),成人組腦脊液常規(guī)異常表現(xiàn)為有核細(xì)胞數(shù)升高9例(32.1%),腦脊液蛋白升高3例(9.4%)。兒童組、成人組腦脊液糖氯均基本正常。兒童組腦脊液抗nmdar抗體陽性率為100%,血清抗nmdar抗體陽性24例(75%);腦脊液抗nmdar抗體陽性率為100%,血清抗nmdar抗體陽性率為22例(68.75%)。(2)腦電圖:兒童組32例中有1例未行腦電圖檢查,腦電圖異常31例(100%),全腦多部位δ刷4例(12.5%)。成人組腦電圖異常28例(100%),典型的δ刷(edb)5例(15.6%)。(3)頭顱mri/ct:兒童組:32例患兒有3例未行頭顱mri或頭顱ct檢查,異常14例(48.3%)。成人組28例患者中有1例未行頭顱ct/mri檢查,異常13例(48.1%)。⑸預(yù)后:腦脊液抗nmdar抗體滴度1:10組vs1:16組,1:10組vs≥1:32組mrs評分t檢驗,p值0.05,差異有統(tǒng)計學(xué)意義。腦脊液抗nmdar抗體滴度1:16組vs≥1:32組mrs評分行t檢驗,p值0.05,差異無統(tǒng)計學(xué)意義。腦脊液抗nmdar抗體滴度1:10組vs1:16組、1:10組vs≥1:32組及1:16組vs≥1:32組時住院日進(jìn)行t檢驗,p值均0.05,差異無統(tǒng)計學(xué)意義。出院時MRS≤2分的患者在兒童構(gòu)成比與成人構(gòu)成比及男性構(gòu)成比與女性構(gòu)成比差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:⑴以精神行為異常、癲癇發(fā)作、精神行為異常+癲癇發(fā)作為首發(fā)癥狀的抗NMDAR腦炎患者在兒童構(gòu)成比與成人構(gòu)成比及男性構(gòu)成比與女性構(gòu)成比無差別。⑵兒童常見的癥狀:精神行為異常、語言障礙、認(rèn)知功能障礙、運(yùn)動障礙、癲癇發(fā)作、自主神經(jīng)功能障礙、睡眠障礙、不同程度的意識水平下降。成人常見的癥狀:癲癇發(fā)作、認(rèn)知功能障礙、精神行為異常、中樞性低通氣、運(yùn)動障礙、自主神經(jīng)功能障礙、意識障礙。成人比兒童更容易發(fā)生癲癇、中樞性低通氣,兒童相比成人易發(fā)生精神異常、疾病再次復(fù)發(fā)。認(rèn)知功能障礙、運(yùn)動功能障礙、神經(jīng)功能障礙、意識障礙臨床表現(xiàn)在兒童發(fā)與成年人中發(fā)生概率無差別別。(3)出院時MRS≤2分的患者在兒童構(gòu)成比與成人構(gòu)成比及男性構(gòu)成比與女性構(gòu)成比差異無統(tǒng)計學(xué)意義(P0.05)。腦脊液抗NMDAR抗體滴度1:10組比1:16組、≥1:32組預(yù)后好,腦脊液NMDAR抗體滴度1:16組與≥1:32組預(yù)后無差異。
[Abstract]:Objective: to analyze the clinical manifestations, auxiliary examination, treatment and prognosis of anti NMDAR encephalitis in children and adults, and to compare the clinical manifestations and prognosis of anti NMDAR encephalitis in children and adults in order to deepen the understanding of NMDAR encephalitis. Methods: to collect the First Affiliated Hospital of Guangxi Medical University and the second affiliated medicine from 01 to March 2017 2014. In the Department of Neurology, 60 patients with anti NMDAR encephalitis were included in the Department of Pediatrics, and 60 patients who were in conformity with the inclusion criteria were retrospectively analyzed, and their demographic data, medical history, clinical manifestation, laboratory examination, imaging examination and treatment effect were collected. The age of age less than 14 years old was classified as a child group, and the age of 14 years as an adult group. The clinical characteristics of two groups of patients and the difference of children and adults in clinical manifestation and prognosis were compared. Results: (1) basic situation: 60 cases of anti NMDAR encephalitis, including 31 cases of male and 29 women, 28 cases in adult group, 32 cases in children group, 3-51 years in age area, and 7.8 + 3.3 years old in the children group. The average age of onset was 28.4 + 12 years. (2) the incidence of prodrome symptoms: 13 cases (40.6%) in children group and 13 cases in adult group (46.4%). (3) the first symptom was the first symptom of abnormal mental behavior: 14 cases in children group (43.8%), 8 in adult group (28.6%); epileptic seizures: children group 7 (21.9%), adult group, epileptic seizure: children group 8.8%), in the adult group, 7 cases (25%). In addition, 3 cases (9.4%) in the children group were the first symptom of limb weakness; in the adult group, 3 cases (10.7%), 3 lower extremities and unstable walking (7.1%) were found in the adult group. The patients with anti NMDAR encephalitis with mental and behavioral abnormalities, epileptic seizures, and mental behavior abnormal + epilepsy were formed in children's composition ratio. There was no significant difference in the proportion of adult constitution ratio and male constitution ratio (P0.05). (3) the clinical manifestations of epilepsy were 23 cases (71.8%) in children group, 26 cases in adult group (92.9%), 29 cases in children (90.6%), 24 in adult group (85.7%), and 24 in adult group (85.7%); all children in the children group had different types of sperm. There were 32 cases of deity (100%), 23 cases in adult group (82.1%), 3 cases in children group (9.4%), 21 cases in adult group (75%), 27 cases in children group (84.3%), 20 in adult group (71.4%); autonomic nervous dysfunction: pediatric group 20 cases (62.5%), adult group, adult group, adult group; disease recurrence: There were 12 cases (37.5%) in children and 2 cases (7.1%) in adult group. In addition, 30 cases (93.7%) had language disorder, 19 cases (59.3%) had sleep disorder, epileptic seizures, psychosis, central hypoventilation, and the incidence of recurrent symptoms in children and adults, P0.05, there was statistical significance. Cognitive dysfunction, motor dysfunction, The clinical manifestations of neural dysfunction and disturbance of consciousness were compared in children and adults. There was no statistical difference in P0.05. (1) cerebrospinal fluid pressure in children was normal, 8 cases in the adult group increased (28.6%). Cerebrospinal fluid routine, biochemistry: 6 cases in children group and 6 cases of nuclear cells (18.8%). The protein increased in 1 cases (3.12%). The normal abnormal cerebrospinal fluid in the adult group was 9 cases (32.1%) and 3 cases of cerebrospinal fluid protein (9.4%). In the children group, the cerebrospinal fluid glucose and chloride in the adult group were basically normal. The anti NMDAR antibody positive rate of the cerebrospinal fluid in the children group was 100%, the serum anti NMDAR antibody positive was 24 cases (75%), and the positive rate of anti NMDAR antibody in cerebrospinal fluid was the positive rate in the cerebrospinal fluid. 100%, the positive rate of serum anti NMDAR antibody was 22 cases (68.75%). (2) electroencephalogram: 1 cases in 32 cases of children were not examined by electroencephalogram, 31 cases of electroencephalogram (100%), 4 (12.5%) with delta brush in the whole brain (12.5%), 28 (100%) in adult group and typical delta brush (68.75%). Cranial CT examination, abnormal 14 cases (48.3%). 28 cases in adult group had 1 cases without head ct/mri examination, abnormal 13 cases (48.1%). The prognosis of anti NMDAR antibody titer in cerebrospinal fluid at 1:10 group was vs1:16 group, vs above Mrs score of vs in 1:10 group and P value 0.05, the difference was statistically significant. Mrs score of vs of anti NMDAR antibody titer group of cerebrospinal fluid was tested for t test. The p value was 0.05, the difference was not statistically significant. The anti NMDAR antibody titer in the cerebrospinal fluid was in the vs1:16 group at 1:10 group, in the 1:10 group, and in the group of vs more or more than in the group vs, and the p value was 0.05, the difference was not statistically significant. There was no difference in the ratio of the constitution ratio of the children with the adult to the adult constitution and the ratio of the male constitution to the female constitution. Statistical significance (P0.05). Conclusion: (1) there is no difference in the ratio of the composition ratio of the children to the adult constitution ratio and the male constitution ratio and the female constitution ratio with the mental behavior abnormalities, the epileptic seizures, the mental behavior abnormal + epilepsy as the first symptom. (2) the common symptoms of children: mental and behavioral disorders, language disorders, cognitive dysfunction, transportation. Dyskinesia, epileptic seizures, autonomic nervous dysfunction, sleep disorders, and lower levels of consciousness. Common symptoms in adults: epileptic seizures, cognitive dysfunction, abnormal mental behavior, central hypoventilation, dyskinesia, autonomic dysfunction, disturbance of consciousness. Adults are more prone to epilepsy, central hypoventilation than children. There is no difference in the incidence of cognitive dysfunction, motor dysfunction, neurological dysfunction, and consciousness disorder in children's hair and adults. (3) the ratio of MRS to 2 in the discharge of children is compared with the proportion of the adult constitution ratio and the male constitution ratio and the female constitution ratio. There was no statistical significance (P0.05). The anti NMDAR antibody titer in cerebrospinal fluid at 1:10 group was better than that in the 1:16 group, and the prognosis was better than that of the group. There was no difference in the prognosis of the NMDAR antibody titer in cerebrospinal fluid and the prognosis.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R742.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張琴;曾麗;;兒童和成人抗N-甲基-D-天冬氨酸受體腦炎的臨床特征[J];中國神經(jīng)精神疾病雜志;2016年11期

2 賈珊珊;劉小紅;汪東;趙斯鈺;;抗NMDA受體腦炎12例臨床腦電圖分析及文獻(xiàn)回顧[J];中國婦幼健康研究;2016年08期

3 任彩霞;余永平;馮丙東;;抗NMDA受體腦炎42例臨床分析[J];陜西醫(yī)學(xué)雜志;2016年09期

4 王昕;楊健;李爾珍;王立文;王s，

本文編號：1923844