癫痫杂志

癫痫杂志

抗N-甲基-D-天冬氨酸受体脑炎在四川省的诊断现状及流行病学特征

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目的分析抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎在中国四川省的诊断现状及流行病学特征。 方法运用回顾性研究的方法,收集并分析2012年1月-2017年2月四川省各级医院送检疑诊为自身免疫性脑炎患者,并送检抗NMDAR抗体的病例资料。 结果① 送检病例共1 714例,省会级城市医院从2012年开始送检,共送检1 511例,非省会级城市的医院2014年开始送检,共203例;送检医院逐年增多。送检科室涉及神经内科、心理科、精神科、ICU、儿科、老年病科、耳鼻喉科、感染科、急诊科、呼吸科。② 送检例数逐年增多,确诊患者155例,其中女89例,男66例;年龄9~77岁,平均(27.9±12.0) 岁;女性平均年龄(26.5±11.31) 岁,男性平均年龄(29.0±13.0) 岁。男女患者均以10~29岁年龄段构成比较高。③ 确诊的患者中,127例临床资料详尽,以癫痫和精神行为异常为主要症状,首诊误诊率为84.3%,18例患肿瘤(女17例,畸胎瘤占11/17)。 结论四川省非省会级城市医院对自身免疫性脑炎认识程度有待提高;抗NMDAR脑炎可就诊于多个科室,早期易误诊。

ObjectiveTo analyze the diagnosis status and epidemiological characteristics of anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR encephalitis) in the Sichuan province of China. MethodsIn the retrospective survey study, data of cases suspected as autoimmune encephalitis in Sichuan province from January 2012 to February 2017 were collected from the third-party test center.The diagnosis status and epidemiological characteristics of anti-NMDAR encephalitis were analyzed. Results① A total of 1 714 cases had been suspected as autoimmune encephalitis with anti NMDA receptor antibodies tested.In hospitals of capital city, cerebrospinal fluid or serum of 1 511 cases were tested since 2012.In other cities, 203 cases were tested since 2014.Hospitals with anti NMDA receptor antibodies tested increased by year.The cases distributed in the department of neurology, psychology, pychiatric, ICU, pediatrics, geriatrics, otolaryngology, infection, the mergency department and pneumology.② Cases with anti NMDA receptor antibodies tested increased by year.A total of 155 cases were confirmed as anti-NMDAR encephalitis, with the average onset age of (27.9±12.0) years ranged from 9 years to 77 years, including 89 women and 66 male.The female average age were (26.5±11.31) years, while the male were(29.0±13.0) years.③ Among the 155 confirmed cases, 127 cases with detailed clinical data were analyzed further.Seizure and behavior disorder were the main symptoms at onset.Among the 127 cases, 107 cases were misdiagnosed at their first hospital visit, with the misdiagnose rate of 84.3%.18 cases were reported with tumors (17 female), mainly with teratoma(11/17). ConclusionIn Sichuan province, the doctors of hospitals in non-capital city should strengthen the identification of autoimmune encephalitis.Anti-NMDAR encephalitis could be misdiagnosed easily and non-neurological physicians should also take attention;

关键词: 抗N-甲基-D-天冬氨酸受体脑炎; 四川省; 诊断现状; 流行病学

Key words: Anti-N-methyl-D-aspartate receptor encephalitis; Sichuan province; Diagnosis status; Epidemiology

引用本文: 郭永华, 佐小丽, 徐安璟, 邓小娟, 邓艳, 刘勇, 晏子俊, 张杨, 熊毅, 周静, 周东, 洪桢. 抗N-甲基-D-天冬氨酸受体脑炎在四川省的诊断现状及流行病学特征. 癫痫杂志, 2017, 3(5): 373-379. doi: 10.7507/2096-0247.20170057 复制

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