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目的了解抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎分型、疗效和预后。方法 2013年1月~2015年8月在武汉同济医院和襄阳市中心医院收集抗NMDAR脑炎确诊患者。抗体检测方法均采用转染细胞免疫荧光法(CBA),将抗NMDAR脑炎分为三种亚型,急性期治疗方案首选采用甲强龙冲击治疗、丙种球蛋白(0.4 g·kg~(-1)·d~(-1),5 d)、血浆置换治疗,二线治疗方案为环磷酰胺,随访方法为12个月改良Rankin量表。结果 32例患者完成研究,所有患者均没有发现畸胎瘤等肿瘤。32例患者采用甲强龙冲击治疗方案;对疗效不佳的23例患者又采用丙种球蛋白治疗;没有患者行血浆转换;9例患者采用免疫抑制剂治疗方案。12个月时改良Rankin量表(0~2分)转归为24例。结论采用国外学者提出的诊断标准、临床分型和治疗方案后大部分抗NMDAR脑炎患者取得较好疗效。
Objective To understand the classification, efficacy and prognosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Methods From January 2013 to August 2015, patients diagnosed with anti-NMDAR encephalitis were collected in Wuhan Tongji Hospital and Xiangyang Central Hospital. Antibodies were detected by transfected cells immunofluorescence (CBA), the anti-NMDAR encephalitis is divided into three subtypes, the first choice of acute treatment with methylprednisolone therapy, gamma globulin (0.4 g · kg ~ (- 1) · d ~ (-1), 5 d). Plasma exchange was used for the second-line treatment for cyclophosphamide. The follow-up method was a modified 12-month Rankin scale. Results 32 patients completed the study, all patients did not find tumors such as teratoma. Thirty-two patients were treated with methylprednisolone; 23 patients with poor response were treated with gamma globulin; no patient underwent plasma conversion; and nine patients received immunosuppressive therapy. At 12 months, the modified Rankin scale (0 to 2) was assigned to 24 patients. Conclusion Most of the patients with anti-NMDAR encephalitis achieved better curative effect after using the diagnostic criteria, clinical classification and treatment plan proposed by foreign scholars.