儿童抗N-甲基-D-天门冬氨酸受体脑炎免疫治疗进展

张展, 方峰

中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (9) : 781-785.

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中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (9) : 781-785. DOI: 10.7499/j.issn.1008-8830.2018.09.017
综述

儿童抗N-甲基-D-天门冬氨酸受体脑炎免疫治疗进展

  • 张展, 方峰
作者信息 +

Progress in immunotherapy for children with anti-N-methyl-D-aspartate receptor encephalitis

  • ZHANG Zhan, FANG Feng
Author information +
文章历史 +

摘要

抗N-甲基-D-天门冬氨酸受体(NMDAR)脑炎是近年被报道的一种自身免疫性脑炎。目前国内外尚无针对该病的儿童及青少年患者的统一治疗方案,免疫治疗仍是主要的治疗措施,应用较为广泛的包括一线免疫治疗、二线免疫治疗及长程免疫治疗。近年来也有学者尝试应用新型免疫抑制剂或改进现有免疫治疗方案来提高对儿童及青少年患者的治疗效果,该文将尝试总结相关免疫治疗方案,并对免疫治疗研究方向做一展望。

Abstract

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune encephalitis that was reported in recent years. At present, there remains no unified treatment regimen for the children and adolescents with this disease around the world. Immunotherapy is still the preferred way of treatment, mainly including first-line immunotherapy, second-line immunotherapy, and long-term immunotherapy. In recent years, some researchers have tried new immunosuppressants or modified immunotherapy regimens to improve the treatment outcome of the patients. This article summarizes related immunotherapy regimens, as well as the future direction of research on immunotherapy for anti-NMDAR encephalitis.

关键词

抗N-甲基-D-天门冬氨酸受体脑炎 / 免疫治疗 / 儿童

Key words

Anti-N-methyl-D-aspartate receptor encephalitis / Immunotherapy / Child

引用本文

导出引用
张展, 方峰. 儿童抗N-甲基-D-天门冬氨酸受体脑炎免疫治疗进展[J]. 中国当代儿科杂志. 2018, 20(9): 781-785 https://doi.org/10.7499/j.issn.1008-8830.2018.09.017
ZHANG Zhan, FANG Feng. Progress in immunotherapy for children with anti-N-methyl-D-aspartate receptor encephalitis[J]. Chinese Journal of Contemporary Pediatrics. 2018, 20(9): 781-785 https://doi.org/10.7499/j.issn.1008-8830.2018.09.017

参考文献

[1] Dalmau J, Tüzün E, Wu HY, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma[J]. Ann Neurol, 2007, 61(1):25-36.
[2] Guan HZ, Ren HT, Cui LY. Autoimmune encephalitis:an expanding frontier of neuroimmunology[J]. Chin Med J (Engl), 2016, 129(9):1122-1127.
[3] Gable MS, Sheriff H, Dalmau J, et al. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project[J]. Clin Infect Dis, 2012, 54(7):899-904.
[4] McKeon A. The importance of early and sustained treatment of a common autoimmune encephalitis[J]. Lancet Neurol, 2013, 12(2):123-125.
[5] Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis:an observational cohort study[J]. Lancet Neurol, 2013, 12(2):157-165.
[6] Byrne S, McCoy B, Lynch B, et al. Does early treatment improve outcomes in N-methyl-D-aspartate receptor encephalitis?[J]. Dev Med Child Neurol, 2014, 56(8):794-796.
[7] Leypoldt F, Gelderblom M, Schöttle D, et al. Recovery from severe frontotemporal dysfunction at 3 years after N-methyl-d-aspartic acid (NMDA) receptor antibody encephalitis[J]. J Clin Neurosci, 2013, 20(4):611-613.
[8] 中华医学会神经病学分会. 中国自身免疫性脑炎诊治专家共识[J]. 中华神经科杂志, 2017, 50(2):91-98.
[9] Zekeridou A, Karantoni E, Viaccoz A, et al. Treatment and outcome of children and adolescents with N-methyl-D-aspartate receptor encephalitis[J]. J Neurol, 2015, 262(8):1859-1866.
[10] 张炜华, 王晓慧, 方方, 等. 抗N-甲基-D-天冬氨酸受体脑炎102例临床特征及随访[J]. 中国循证儿科杂志, 2016, 11(3):182-186.
[11] Nagappa M, Bindu PS, Mahadevan A, et al. Clinical features, therapeutic response, and follow-up in pediatric anti-N-methyl-D-aspartate receptor encephalitis:experience from a tertiary care university hospital in India[J]. Neuropediatrics, 2016, 47(1):24-32.
[12] 袁晶, 彭斌, 关鸿志, 等. 重症抗N-甲基-D-天冬氨酸受体脑炎35例免疫治疗分析[J]. 中华医学杂志, 2016, 96(13):1035-1039.
[13] Turkdoğan D, Orengul AC, Zaimoğlu S, et al. Anti-N-methyl-D-aspartate (Anti-NMDA) receptor encephalitis:rapid and sustained clinical improvement with steroid therapy starting in the late phase[J]. J Child Neurol, 2014, 29(5):684-687.
[14] Zivadinov R. Steroids and brain atrophy in multiple sclerosis[J]. J Neurol Sci, 2005, 233(1-2):73-81.
[15] Appenzeller S, Bonilha L, Rio PA, et al. Longitudinal analysis of gray and white matter loss in patients with systemic lupus erythematosus[J]. Neuroimage, 2007, 34(2):694-701.
[16] Hung TY, Foo NH, Lai MC. Anti-N-methyl-D-aspartate receptor encephalitis[J]. Pediatr Neonatol, 2011, 52(6):361-364.
[17] Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis:the sixth special issue[J]. J Clin Apher, 2013, 28(3):145-284.
[18] DeSena AD, Noland DK, Matevosyan K, et al. Intravenous methylprednisolone versus therapeutic plasma exchange for treatment of anti-N-methyl-D-aspartate receptor antibody encephalitis:a retrospective review[J]. J Clin Apher, 2015, 30(4):212-216.
[19] 张桂菊, 刘小荣, 孟繁英, 等. 血浆置换在儿科的应用:附93例病例分析[J]. 中国小儿急救医学, 2015, 22(7):458-461.
[20] Kreye J, Wenke NK, Chayka M, et al. Human cerebrospinal fluid monoclonal N-methyl-D-aspartate receptor autoantibodies are sufficient for encephalitis pathogenesis[J]. Brain, 2016, 139(Pt 10):2641-2652.
[21] Dale RC, Pillai S, Brilot F. Cerebrospinal fluid CD19(+) B-cell expansion in N-methyl-D-aspartate receptor encephalitis[J]. Dev Med Child Neurol, 2013, 55(2):191-193.
[22] Harjunpää A, Wiklund T, Collan J, et al. Complement activation in circulation and central nervous system after rituximab (anti-CD20) treatment of B-cell lymphoma[J]. Leuk Lymphoma, 2001, 42(4):731-738.
[23] 卢强, 关鸿志, 任海涛, 等. 应用利妥昔单抗治疗抗N-甲基-D-天冬氨酸受体脑炎三例临床观察[J]. 中华神经科杂志, 2016, 49(1):30-34.
[24] 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.
[25] Dale RC, Brilot F, Duffy LV, et al. Utility and safety of rituximab in pediatric autoimmune and inflammatory CNS disease[J]. Neurology, 2014, 83(2):142-150.
[26] Kavcic M, Fisher BT, Seif AE, et al. Leveraging administrative data to monitor rituximab use in 2875 patients at 42 freestanding children's hospitals across the United States[J]. J Pediatr, 2013, 162(6):1252-1258, 1258.e1.
[27] 赵力立, 罗蓉. 儿童抗N-甲基-D-天冬氨酸受体脑炎3例报告[J]. 中国实用儿科杂志, 2016, 31(4):315-317.
[28] Gabilondo I, Saiz A, Galán L, et al. Analysis of relapses in anti-NMDAR encephalitis[J]. Neurology, 2011, 77(10):996-999.
[29] 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.
[30] Clowse ME, Behera MA, Anders CK, et al. Ovarian preservation by GnRH agonists during chemotherapy:a meta-analysis[J]. J Womens Health (Larchmt), 2009, 18(3):311-319.
[31] Byrne S, Jordan I, Redmond J. Prevalence and treatment of anti-NMDA receptor encephalitis[J]. Lancet Neurol, 2013, 12(5):424.
[32] Bravo-Oro A, Abud-Mendoza C, Quezada-Corona A, et al. Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis:experience with six pediatric patients. Potential efficacy of methotrexate[J]. Rev Neurol, 2013, 57(9):405-410.
[33] Tatencloux S, Chretien P, Rogemond V, et al. Intrathecal treatment of anti-N-Methyl-D-aspartate receptor encephalitis in children[J]. Dev Med Child Neurol, 2015, 57(1):95-99.
[34] Hacohen Y, Wright S, Waters P, et al. Paediatric autoimmune encephalopathies:clinical features, laboratory investigations and outcomes in patients with or without antibodies to known central nervous system autoantigens[J]. J Neurol Neurosurg Psychiatry, 2013, 84(7):748-755.
[35] Wang H. Efficacies of treatments for anti-NMDA receptor encephalitis[J]. Front Biosci (Landmark Ed), 2016, 21:651-663.
[36] 关鸿志, 崔丽英. 自身免疫性脑炎诊疗的规范化势在必行[J]. 中华神经科杂志, 2017, 50(2):81-82.
[37] Gresa-Arribas N, Titulaer MJ, Torrents A, et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis:a retrospective study[J]. Lancet Neurol, 2014, 13(2):167-177.
[38] Schein F, Gagneux-Brunon A, Antoine JC, et al. Anti-N-methyl-D-aspartate receptor encephalitis after Herpes simplex virus-associated encephalitis:an emerging disease with diagnosis and therapeutic challenges[J]. Infection, 2017, 45(4):545-549.

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