Abstract:

Objective To analyze the clinical characteristics and prognosis of anti-NMDA receptor encephalitis in children versus adults, and to provide guidance for the diagnosis and treatment of anti-NMDA receptor encephalitis in children and adults. Methods　The clinical data of 46 patients with anti-NMDA receptor antibody-positive encephalitis diagnosed after hospitalization at Guangdong 999 Brain Hospital from January 2017to January 2019 were retrospectively analyzed. The patients were divided into a children group (<14 years old) and an adult group (≥14 years old). There were 11 children and 35 adults. The children group were (7.6±3.7) years old. The adult group were (27.4±13.0) years old. The first symptoms, main clinical symptoms, auxiliary examination results, and prognosis of the two groups were compared and analyzed. χ² test was applied. Results　The main first symptom was mental symptom in both groups; 9 (81.8%) children' first symptom was mental symptom, and 18 (51.4%) adults'. Main clinical symptoms: the incidence of central hypoventilation in the children was lower than that in the adults [9.1% (1/11) vs. 25.7% (9/35)]; more children had extrapyramidal system symptoms than the adults [36.4% (4/11) vs. 11.4% (4/35)]; there were statistical differences (χ²=3.36 and 3.62; both P<0.05). Auxiliary examination: the positive rate of abdominal ultrasound or CT in the adults was lower higher than that in the children [14.3% (5/35) vs. 0], with a statistical difference (χ²=2.16, P<0.05). Conclusions　Anti-NMDA receptor encephalitis has varied clinical symptoms, but both children and adults usually start with abnormal mental behaviors, especially children. Fewer children have central hypoventilation than adults, but they are more likely to develop extrapyramidal symptoms. This study suggests that there are differences between children and adults with anti-NMDA receptor encephalitis. Primary physicians should be sensitive and prudent in the diagnosis and treatment of pediatric encephalitis, and try to strengthen the understanding of the disease so as to achieve early diagnosis and treatment and improve prognosis.

Key words:

Anti-NMDA receptor encephalitis, Clinical analysis, Magnetic resonance imaging, Cerebrospinal fluid, Electroencephalogram

摘要：

目的　通过探究儿童与成人抗Ｎ-甲基-Ｄ-天冬氨酸（NMDA）受体脑炎的临床特点和预后的差异性，为儿童与成人抗NMDA受体脑炎患者的诊断和治疗提供指导依据。方法　回顾性分析2017年1月至2019年1月广东三九脑科医院住院治疗后确诊的46例抗NMDA受体抗体阳性脑炎患者的临床资料，按年龄分为儿童组和成人组，年龄<14岁纳入儿童组，年龄≥14岁纳入成人组，其中儿童组有11例，年龄（7.6±3.7）岁；成人组有35例患者，年龄（27.4±13.0）岁。对比分析儿童组和成人组首发症状、主要临床症状、辅助检查及预后的差异。统计学方法采用χ²检验。结果　首发症状：儿童和成人两组首发症状均以精神症状为主，儿童组尤为显著，儿童组9例（81.8%），成人组18例（51.4%）。主要临床症状：儿童中枢性低通气的发生明显少于成人组［9.1%（1/11）比25.7%（9/35）］，儿童较成人患者更容易出现锥体外系症状［36.4%（4/11）比11.4%（4/35）］，差异均有统计学意义（χ²=3.36、3.62，均P<0.05）。辅助检查：所有患者的脑脊液都存在异常；成人腹部B超或CT阳性率高于儿童［14.3%（5/35）比0］，差异有统计学意义（χ²=2.16，P<0.05）。结论　抗NMDA受体脑炎临床症状多样，但儿童和成人都多以精神症状为首发症状，且儿童尤为显著。与成人相比，儿童较少发生中枢性低通气症状，但更易出现锥体外系症状。本研究提示儿童抗NMDA受体脑炎与成人的存在差异，对于临床医师在临床儿童脑炎的诊治时，需要敏锐和审慎鉴别，加强该病认识，以达到尽早诊断治疗，改善预后。

关键词:

抗NMDA受体脑炎, 临床分析, 磁共振成像, 脑脊液, 脑电图