儿童抗N-甲基-D-天门冬氨酸受体脑炎的治疗

钟建民

doi:10.7499/j.issn.1008-8830.2014.06.005

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中国当代儿科杂志 ›› 2014, Vol. 16 ›› Issue (6) : 584-588. DOI: 10.7499/j.issn.1008-8830.2014.06.005

抗NMDAR脑炎专题

儿童抗N-甲基-D-天门冬氨酸受体脑炎的治疗

钟建民

作者信息 +

Management of anti-N-methyl-D-aspartate receptor encephalitis in children

ZHONG Jian-Min

Author information +

Department of Pediatric Neurology, Jiangxi Children's Hospital, Nanchang 330006, China

Aboat authors:

[1] Hung TY, Foo NH, Lai MC. Anti-N-methyl-D-aspartate receptor encephalitis[J].Pediatr Neonatol, 2011, 52(6): 361-364.
[2] Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti- NMDAR encephalitis[J].Lancet Neurol, 2011, 10(1): 63-74.
[3] Beatty CW, Creutzfeldt CJ, Davis AP, et al. The diagnostic conundrum and treatment dilemma of a patient with a rapidly progressive encephalopathy[J].Neurohospit, 2014, 4(1): 34-41.
[4] McKeon A. The importance of early and sustained treatment of a common autoimmune encephalitis[J].Lancet Neurol, 2013, 12(2): 123-125.
[5] 官文征,王华. 抗NMDAR 脑炎诊治进展[J].中国实用儿科杂志, 2012, 27(12): 950-953.
[6] Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti- N-Methyl-D-Aspartate (NMDA) receptor encephalitis: a cohort study[J].Lancet Neurol, 2013, 12(2): 157-165.
[7] 陈晨, 彭镜. 儿童抗N-甲基-D-天冬氨酸受体脑炎[J].国际儿科学杂志, 2013, 40(2):179-182.
[8] 童晶晶, 陈贵海. 抗N-甲基-D-天冬氨酸受体脑炎[J].中华神经科杂志, 2011, 44(7): 504-506.
[9] 吴春华, 文薇. 抗N-甲基-D-天冬氨酸受体脑炎[J].云南医药, 2012, 33(6): 579-582.
[10] 张长平, 崔向丽,杨莉. 糖皮质激素在病毒性脑炎中的应用[J].药学评价, 2011, 8(22): 20-30.
[11] 乔娜娜, 孙若鹏. 儿童抗N-甲基-D-天冬氨酸受体抗体脑炎[J].国际儿科学杂志, 2013, 40(5): 481-484.
[12] 钟建民. 肾上腺皮质激素在儿科癫癎中的应用[J].国际儿科学杂志, 2013, 40(5): 522-525.
[13] 路屹, 马博, 路宁. 免疫吸附疗法治疗神经系统免疫性疾病的临床效果观察[J].南通大学学报( 医学版), 2014, 34(1): 50-52.
[14] Wong-Kisiel LC, Ji T, Renaud DL, et al. Response to immunotherapy in a 20-month-old boy with anti- NMDA receptor encephalitis[J].Neurology, 2010, 74(19): 1550-1551.
[15] 陈永, 高永艳, 李艳, 等. 利妥昔单抗致不良反应325 例文献分析[J].广东药学院学报, 2010, 26(2): 179-181.
[16] Iizuka T, Sakai F, Ide T, et al. Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal[J].Neurology, 2008, 70(7): 504-511.
[17] Kirkpatrick MP, Clarke CD, Sonmezturk HH, et al. Rhythmic delta activity represents a form of nonconvulsive status epilepticus in anti-NMDA receptor antibody encephalitis[J].Epilepsy Behav, 2011, 20(2): 392-394.
[18] 钟建民. 儿童惊厥的诊断与急救处理[J].中国小儿急救医学, 2011, 18(5): 388-390.
[19] Schmitt SE, Pargeon K, Frechette ES, et al. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis[J].Neurology, 2012, 79(11): 1094-1100.
[20] Di Capua D, García-Ptacek S, García-García ME, et al. Extreme delta brush in a patient with anti-NMDAR encephalitis[J].Epileptic Disord, 2013, 15 (4): 461-464.
[21] Baizabal-Carvallo JF, Stocco A, Muscal E, et al. The spectrum of movement disorders in children with anti-NMDA receptor encephalitis[J].Mov Disord, 2013, 28(4): 543-547.
[22] 易招师, 查剑, 钟建民, 等. 病毒性脑炎所致阵发性自主神经性不稳伴肌张力不全1 例[J].亚洲儿科病例研究, 2013, 1(3): 41-44.

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文章历史 +

摘要

抗N-甲基-D-天门冬氨酸受体（NMDAR）脑炎是新认识的一种严重、潜在可治的自身免疫性脑炎，可见于任何年龄，但以儿童更为常见。该病具有显著特征性，病程可分为五期，即病毒感染样症状的前驱期、精神症状期、意识障碍期、异常运动期和恢复期。该病主要治疗包括一线免疫治疗如皮质类固醇激素、静脉丙种球蛋白和血浆交换治疗；二线免疫治疗如利妥昔单抗和环磷酰胺等及肿瘤切除。该文主要介绍抗NMDAR 脑炎各种治疗方法的进展、选择及治疗的局限和不足，以期对该病的临床治疗有所帮助。

Abstract

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a new category of severe, potentially treatable autoimmune encephalitis and can appear in patients of all ages, but more frequently in children. It is a highly characteristic syndrome evolving in five stages: the prodromal phase (viral infection-like symptoms), psychotic phase, unresponsive phase, hyperkinetic phase, and gradual recovery phase. The treatment for this disorder includes firstline immunotherapy (steroids, intravenous immunoglobulin, plasmapheresis), second-line immunotherapy (rituximab, cyclophosphamide), and tumor removal. Hereby the progresses, selections and shortcomings of the treatment protocols for this disease are introduced.

导出引用

钟建民. 儿童抗N-甲基-D-天门冬氨酸受体脑炎的治疗[J]. 中国当代儿科杂志. 2014, 16(6): 584-588 https://doi.org/10.7499/j.issn.1008-8830.2014.06.005

ZHONG Jian-Min. Management of anti-N-methyl-D-aspartate receptor encephalitis in children[J]. Chinese Journal of Contemporary Pediatrics. 2014, 16(6): 584-588 https://doi.org/10.7499/j.issn.1008-8830.2014.06.005