儿童抗N-甲基-D-天冬氨酸受体脑炎的影像表现与临床特征

doi:10.12117/jccmi.2019.11.003

摘要
图/表
参考文献(19)
相关文章 (3)

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：分析儿童抗N-甲基-D-天冬氨酸（N-methyl-D-aspartate，NMDA）受体脑炎头颅MRI表现与临床特征。方法：对34例抗NMDA受体脑炎患儿进行影像资料与临床资料综合分析，并在入院时、入院治疗6月后全部进行改良的疾病严重程度评分（mRS）。结果：34例患儿中17例MRI表现异常，MRI表现异常者T2WI、FLAIR序列呈高信号。异常信号灶多分布于颞叶、岛叶、额顶枕叶，部分病灶亦可见于基底节、丘脑、胼胝体及脑干、小脑，其中6例伴有脑膜和/或脑实质病灶明显强化。首发症状癫痫位于第一位（74%），其次精神行为异常（35%）、发热（32%）、运动障碍（17.6%）、意识障碍（17.6%）。癫痫发作、精神行为异常、发热、运动障碍、意识障碍、单纯疱疹病毒感染患儿MRI表现正常者与MRI表现异常者差异无统计学意义（P＞0.05），34例患儿中MRI表现正常与MRI表现异常的年龄分布差异无统计学意义（P＞0.05）。入院mRS评分，MRI表现正常者与MRI表现异常者差异无统计学意义（P＞0.05），治疗6月后mRS评分，MRI表现正常者平均评分低于MRI表现异常者，差异有统计学意义（P＜0.05）。结论：儿童抗NMDA抗体受体脑炎MRI表现正常者预后较好、治愈率高，MRI异常者常提示预后较差。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	尹燕
	金科
	庄霞梅
	王海

关键词 ：脑炎；儿童；受体, N-甲基-D-天冬氨酸；磁共振成像

Abstract：Objective: To discuss the imaging and clinical features of anti-N-methyl-D-aspartate(NMDA) receptor encephalitis patients in children. Methods: Thirty-four anti-NMDA receptor encephalitis patients in children were included. We analyzed the brain MRI findings and the clinical characteristics. The modified Rankin scale(mRS) was applied on admission and after 6 months for each patient. Result: The brain MRI was abnormal in 17/34 patients. The initial MRI was abnormal on T2 or fluid-attenuated inversion recovery(FLAIR) as hyper-intensity signals. They were seen in the temporal lobe, insular lobe, frontal and parietal and occipital lobe. Some of them were also found in basal ganglia, thalamus, corpus callosum, brainstemand cerebellum. Six has leptomeningeal enhancement and/or abnormal enhancement of parenchyma. The first symptom is seizure, followed by mental and behavioral disorders(35%), fever(32%), motor disorders(17.6%) and loss of consciousness(17.6%). There were no statistically significant differences between the MRI findings and clinical presentations(seizure, mental and behavioral disorders, fever, motor disorders, oss of consciousness, erpes simplex virus infection)(P>0.05). There was no statistically significant difference in MRI findings(normal or abnormal) between 34 patients with different age(P>0.05). There was no statistically significant difference in MRI findings(normal or abnormal) between the mean mRS score at 0-month follow-up(P>0.05). The mean mRS score at the 6-month follow-up was significantly lower in patients with normal MRI than in patients with abnormal MRI(P<0.05). Conclusion: The patients with normal MRI had improved outcomes, and the patients with abnormal MRI had poor outcoms.

Key words： Encephalitis Child Receptors, N-methyl-D-aspartate Magnetic resonance imaging

收稿日期: 2019-02-01

PACS:	Ｒ512.3
	Ｒ445.2

通讯作者: 金科，湖南省儿童医院放射科，410007。E-mail：jinke001@sina.com

作者简介: 尹燕（1985-），女，湖南衡阳人，主治医师。E-mail：77654549@qq.com

引用本文:

尹燕，金科，庄霞梅，王海. 儿童抗N-甲基-D-天冬氨酸受体脑炎的影像表现与临床特征[J]. 中国临床医学影像杂志, 2019, 30(11): 769-772.
YIN Yan, JIN Ke, ZHUANG Xia-mei, WANG Hai. Imaging and clinical features of anti-N-methyl-D-aspartate receptor encephalitis in children. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(11): 769-772.

链接本文:

http://www.jccmi.com.cn/CN/10.12117/jccmi.2019.11.003 或 http://www.jccmi.com.cn/CN/Y2019/V30/I11/769

[1]Dalmau J, Tuzun 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]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. [3]王晓慧，方方，丁昌红，等. 儿童抗N-甲基-D-天冬氨酸受体脑炎七例[J]. 中华儿科杂志，2012，50（12）：885-889. [4]王华. 儿童抗N-甲基-D-天冬氨酸受体脑炎的诊断与鉴别诊断[J]. 中国当代儿科杂志，2014，16（6）：578-583. [5]王昕，杨健，李尔珍，等. 20例儿童抗N-甲基-D-门冬氨酸受体脑炎的前瞻性研究[J]. 国际儿科学杂志，2016，43（7）：581-583. [6]Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis[J]. Lancet Neurol, 2016, 15(4): 391-404. [7]Bacchi S, Franke K, Wewegama D, et al. Magnetic resonance imaging and positron emission tomography in anti-NMDA receptor encephalitis: A systematic review[J]. J Clin Neurosci, 2018, 52(6): 54-59. [8]Zhuang WH, Cui L, Wang W, et al. Early identification of anti-NMDA receptor encephalitis presenting cerebral lesions in unconventional locations on magnetic resonance imaging[J]. J Neuroimmunol, 2018, 320(7): 101-106. [9]张琴，曾丽. 儿童和成人抗N-甲基-D-天冬氨酸受体脑炎的临床特征[J]. 中国神经精神疾病杂志，2016，42（11）：658-663. [10]Gable MS, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral eiologies in young individuals enrolled in the California encephalitis project[J]. Clin Infect Dis, 2012, 54(7): 899-904. [11]Wang R, Lai XH, Liu X, et al. Brain magnetic resonance-imaging findings of anti-N-methyl-D-aspartate receptor encephalitis: a cohort follow-up study in Chinese patients[J]. J Neurol, 2017, 265(2): 362-369. [12]Armangue T, Titulaer MJ, Malaga I, et al. Pediatric anti-N-methyl-D-aspartate receptor encephalitis clinical analysis and novel findings in a series of 20 patients[J]. J Pediatr, 2013, 162(4): 850-856. [13]张建昭，陈倩，郑萍，等. 伴或不伴头颅磁共振异常的抗N-甲基-D-天冬氨酸受体脑炎患儿的对比研究[J]. 中国当代儿科杂志，2018，1（1）：48-51. [14]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. [15]Lim JA, Lee ST, Jung KH, et al. Anti-N-methyl-D-aspartate receptor encephalitis in Korea: clinical features, treatment, and outcome[J]. Clin Neurol, 2014, 10(2): 157-161. [16]Goldberg EM, Titulaer M, de Blank PM, et al. Anti-N-methyl-D-aspartate receptor-mediated encephalitis in infants and toddlers: case report and review of the literature[J]. Pediatr Neurol, 2014, 50(2): 181-184. [17]Peer M, Pruss H, Dayan B, et al. Functional connectivity of large-scale brain networks in patients with anti-NMDA receptor encephalitis: an observational study[J]. Lancet Psychiatry, 2017, 4(10): 768-774. [18]Finke C, Kopp UA, Pajkert A, et al. Structural hippocampal damage following anti-N-methyl-D-aspartate receptor-mediated encephalitis[J]. Biol Psychiatry, 2016, 79(9): 727-734. [19]Phillios OR, Joshi SH, Narr KL, et al. Superficial white matter damage in anit-NMDA receptor encephalitis[J]. J Neurol Neurosurg Psychiatry, 2018, 89(5): 518-525.