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目的:通过NMDA脑炎与符合可能NMDA脑炎临床诊断标准但NMDA抗体阴性的类NMDA脑病进行比较,从而提高对NMDA脑炎认识,探讨早期鉴别NMDA脑炎。方法:比较2014-08-2016-10我院收治的22例NMDA脑炎患者与19例类NMDA脑病患者的一般资料、临床特征、实验室与辅助检查、治疗反应等方面的差异,并采用改良Rankin量表(mRS)评分评估2组患者预后差异。结果:NMDA脑炎出现中等程度以上发热较少见(P=0.016)。特征性的蟹沫样分泌物、突出的不自主运动、卵巢肿瘤、脑电图特征性极度δ刷仅在NMDA脑炎中出现。颞叶内侧MRI改变差异无统计学意义。2组患者的脑脊液蛋白含量差异有统计学意义(P=0.038)。2组患者mRS评分在入院后的第1个月及第2个月差异具有统计学意义(P=0.011,P=0.045),入院后第2个月2组患者预后比较差异具有统计学意义(P=0.016)。结论:特征性的蟹沫样分泌物、突出的不自主运动、脑电图上极度δ刷与卵巢肿瘤的发现更提示NMDA脑炎的可能,而患者入院时高热与脑脊液蛋白水平显著增高不支持NMDA脑炎的诊断。颞叶内侧MRI异常对NMDA脑炎不具有诊断价值。相对类NMDA脑病而言,NMDA脑炎更容易呈现早期持续进展,恢复缓慢的疾病发展过程。
OBJECTIVE: To compare NMDA encephalitis with NMDA-like NMDA-like encephalopathy that meets the criteria of possible clinical diagnosis of NMDA encephalitis to improve the understanding of NMDA encephalitis and explore early identification of NMDA encephalitis. Methods: The data of 22 patients with NMDA encephalitis and 19 patients with NMDA encephalopathy admitted to our hospital from 2014-08-2016-10 were compared in terms of general information, clinical features, laboratory and auxiliary examination, treatment response and other aspects, The Rankin Scale (mRS) score assessed the difference in prognosis between the two groups. Results: Fever with moderate to moderate fever was more common in NMDA encephalitis (P = 0.016). Characteristic crab-like secretions, prominent involuntary movements, ovarian tumors, EEG characteristic extreme δ brush appears only in NMDA encephalitis. There was no significant difference in medial temporal MRI changes. Cerebrospinal fluid protein content in the two groups was statistically different (P = 0.038). The mRS scores of the two groups were statistically different between the first month and the second month after admission (P = 0.011, P = 0.045). There was significant difference in prognosis between the two groups P = 0.016). CONCLUSIONS: The characteristic crab-like secretions, with pronounced involuntary movements, the extreme δ brush on EEG and the discovery of ovarian tumors are more likely to suggest the possibility of NMDA encephalitis, while patients with high fever and cerebrospinal fluid protein levels are significantly increased on admission NMDA encephalitis diagnosis. The MRI abnormality of medial temporal lobe has no diagnostic value for NMDA encephalitis. Compared to NMDA encephalopathy, NMDA encephalitis is more likely to show early, sustained progression and restore a slow disease progression.