本文選題：自身免疫性腦炎 + 抗NMDAR腦炎��； 參考：《山東大學(xué)》2016年碩士論文

【摘要】：目的本文分析11例自身免疫性腦炎(Autoimmune encephalitis, AE)患者的一般信息、臨床表現(xiàn)、實(shí)驗(yàn)室檢驗(yàn)、影像學(xué)檢查、腦電圖(Electroencephalogram, EEG)結(jié)果、治療方案以及療效,并結(jié)合國內(nèi)外相關(guān)文獻(xiàn),全面討論各型AE的流行病學(xué)特點(diǎn)、發(fā)病機(jī)制、臨床表現(xiàn)、輔助檢查檢驗(yàn)、診斷、治療及預(yù)后,為臨床提供參考。資料與方法本研究收集在2015年3月至2016年2月期間,于山東大學(xué)齊魯醫(yī)院神經(jīng)內(nèi)科住院治療,最后診斷為AE的11例患者,收集患者的一般信息、臨床表現(xiàn)、顱腦磁共振成像(Magnetic resonance Imaging, MRI)、EEG、腦脊液(Cerebrospinal fluid, CSF)及血清學(xué)檢驗(yàn)、治療經(jīng)過和療效。對(duì)收集的11例AE患者資料進(jìn)行回顧性分析。根據(jù)所檢測(cè)的抗體不同,將患者分成不同類型的AE,采用頻數(shù)或百分?jǐn)?shù)描述各組具體情況,分析各類型AE的特點(diǎn)。結(jié)果收集符合腦炎表現(xiàn)并于CSF中檢測(cè)到神經(jīng)細(xì)胞表面抗體(Neuronal surface antibodies, NSAbs)的11例患者,其中抗N-甲基-D-天冬氨酸受體(N-methyl-D-aspartate receptor, NMDAR)腦炎7例、抗富亮氨酸膠質(zhì)瘤失活蛋白1 (Leucine-rich glioma inactivated 1, LGI1)腦炎3例、抗γ-氨基丁酸B受體(γ- aminobutyric acid-B receptor, GABABR)腦炎1例。其中男性患者7例,女性患者4例,年齡為19-71歲�；颊叩呐R床表現(xiàn)包括神經(jīng)精神癥狀,癲癇,認(rèn)知功能減退,煩躁或意識(shí)模糊。血清學(xué)檢測(cè)顯示6例患者血生化異常,其中4例存在低鈉血癥或低氯血癥。6例患者腫瘤系列結(jié)果異常,提示可能存在潛在的腫瘤。CSF中主要是以小淋巴細(xì)胞為主的白細(xì)胞計(jì)數(shù)輕度升高,最高達(dá)120×106/L,蛋白含量正�；蜉p度升高,最高至0.79g/L。6例患者顱腦MRI異常,其中3例為缺血變性灶,1例為海馬、顳葉異常信號(hào),1例為額頂葉、枕葉異常信號(hào),1例為腦動(dòng)脈硬化,余5例患者結(jié)果示未見明顯異常。11例患者在住院期間進(jìn)行腫瘤篩查,1例患者發(fā)現(xiàn)患有子宮肌瘤,1例患者發(fā)現(xiàn)肺癌,但均未行病理學(xué)檢查確診。11例患者中有10例存在腦電圖異常,僅1例正常,其中1例結(jié)果異�；颊唢@示δ刷樣慢活動(dòng)。11例患者中均使用免疫抑制治療,主要是糖皮質(zhì)激素和靜脈注射用免疫球蛋白(Intravenous immunoglobulin, IVIG)。大部分患者治療有效,但出院時(shí)仍存在部分認(rèn)知功能障礙。結(jié)論自身免疫性腦炎主要表現(xiàn)為神經(jīng)精神癥狀,癲癇,認(rèn)知功能減退,煩躁或意識(shí)模糊。輔助檢查中應(yīng)進(jìn)行相關(guān)血液化驗(yàn)以排除其它疾病,并應(yīng)進(jìn)行腫瘤的篩查。CSF改變主要是白細(xì)胞計(jì)數(shù)輕度升高,蛋白含量正�；蜉p度升高。顱腦MRI顯示正�；蜻吘壭阅X炎,EEG檢查一般為異常,但缺乏特異性,然而此兩項(xiàng)檢查對(duì)其它疾病的排除非常重要。目前國際上尚無統(tǒng)一的AE診斷標(biāo)準(zhǔn),臨床上主要依據(jù)詳細(xì)的病史和輔助檢查進(jìn)行診斷,特異性NSAbs檢測(cè)陽性可明確診斷。AE的治療主要是免疫抑制治療,若患者伴發(fā)腫瘤,應(yīng)對(duì)相關(guān)腫瘤進(jìn)行處理。
[Abstract]:Objective to analyze the general information, clinical manifestation, laboratory examination, imaging examination, electroencephalogram (EEG) electroencephalograms (EEGG) results, therapeutic schemes and efficacy of 11 patients with autoimmune encephalitis (AEE). The epidemiological characteristics, pathogenesis, clinical manifestations, auxiliary examination, diagnosis, treatment and prognosis of various types of AE were discussed. Materials and methods from March 2015 to February 2016, 11 patients with AE were admitted to the Department of Neurology, Qilu Hospital, Shandong University, and their general information and clinical manifestations were collected. Magnetic resonance Imaging, Cerebrospinal fluidid, Cerebrospinal fluid (CSF) and serological examination, course of treatment and curative effect. The data of 11 AE patients were analyzed retrospectively. According to the different antibodies detected, the patients were divided into different types of AEs. The specific conditions of each group were described by frequency or percentage, and the characteristics of each type of AE were analyzed. Results 11 patients with neuronal surface antibodies, NSAbs) were detected in CSF. Among them, 7 were anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. There were 3 cases of Leucine-rich glioma inactivated 1 (LGI1) encephalitis and 1 case of 緯 -aminobutyric B receptor (GABA ABR) encephalitis. There were 7 males and 4 females aged 19-71 years. Clinical manifestations include neuropsychiatric symptoms, epilepsy, cognitive impairment, irritability or confusion. The results of serological examination showed that 6 patients had abnormal blood biochemistry, 4 of them had hyponatremia or hypochloremia, and 6 patients had abnormal tumor series. These results suggest that there may be a slight increase in the white blood cell count, mainly small lymphocytes, in the potential tumor. The highest level is 120 脳 10 6 / L, the protein content is normal or slightly elevated, and the maximum is abnormal MRI in the brain of 0.79g/L.6 patients. 3 cases were ischemic degeneration, 1 case was hippocampus, 1 case was frontal and parietal lobe, 1 case was cerebral arteriosclerosis. The results of the remaining 5 patients showed that there was no obvious abnormality. 11 patients underwent tumor screening during hospitalization. One patient found that 1 patient had uterine myoma and 1 patient had lung cancer. However, 10 out of 11 patients who were not diagnosed by pathological examination had abnormal electroencephalogram (EEG). One patient with abnormal results showed 未 brush-like slow activity. 11 patients were treated with immunosuppressive therapy, mainly glucocorticoid and intravenous immunoglobulin (IVIGG). Most of the patients were effective, but there were still some cognitive impairment at discharge. Conclusion the main manifestations of autoimmune encephalitis are neuropsychiatric symptoms, epilepsy, cognitive impairment, irritability or confusion. The related blood tests should be carried out in order to exclude other diseases, and the changes of tumor screening should be mainly caused by slight increase in white blood cell count, normal or slight increase in protein content. Craniocerebral MRI shows normal or marginal encephalitis usually abnormal, but it lacks specificity. However, these two examinations are very important for the exclusion of other diseases. At present, there is no unified diagnostic standard for AE in the world. Clinical diagnosis is mainly based on detailed medical history and auxiliary examination. Specific NSAbs positive detection can clearly diagnose the treatment of immunosuppressive therapy, if the patient is accompanied by tumor, The associated tumors should be treated.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R742.9

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