警惕儿童自身免疫性脑炎诊治陷阱

doi:10.12372/jcp.2023.23e0455

临床儿科杂志 ›› 2023, Vol. 41 ›› Issue (9): 644-649.doi: 10.12372/jcp.2023.23e0455

警惕儿童自身免疫性脑炎诊治陷阱

张炜华¹^,⁴, 邹丽萍²(), 任海涛³, 关鸿志³

1.国家儿童医学中心首都医科大学附属北京儿童医院神经内科（北京 100045）
2.中国人民解放军总医院儿科（北京 100039）
3.中国医学科学院北京协和医院神经科（北京 100005）
4.河南省儿童神经发育工程研究中心河南省儿童医院（郑州儿童医院）郑州大学附属儿童医院（河南郑州 450018）

收稿日期:2022-11-29 出版日期:2023-09-15 发布日期:2023-09-05
通讯作者: 邹丽萍 E-mail:zouliping21@hotmail.com
基金资助:
河南省儿童神经发育工程研究中心开放课题(SG202203)

Beware of the pitfalls in diagnosis and treatment of autoimmune encephalitis in children

ZHANG Weihua¹^,⁴, ZOU Liping²(), REN Haitao³, GUAN Hongzhi³

1. Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing 100045, China
2. Department of Pediatrics, Chinese People's Liberation Army General Hospital, Beijing 100039, China
3. Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100005, China
4. Henan Neurodevelopment Engineering Research Center for Children, Henan Children's Hospital, Zhengzhou Children's Hospital, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, Henan, China

Received:2022-11-29 Published:2023-09-15 Online:2023-09-05
Contact: ZOU Liping E-mail:zouliping21@hotmail.com

摘要/Abstract

摘要：

随着抗神经抗体检测技术的发展，对于自身免疫性脑炎的认知越来越广泛，但诊治水平革新的同时也带来了一定比例的误诊，导致部分患者治疗不当。误诊的主要原因包括不严格执行的诊断标准，不正确的抗体检测结果解读以及不充分的鉴别诊断。相对于成人，儿童自身免疫性脑炎患者的症状识别难度更大，存在区别于成人的抗体谱系及特征，鉴别诊断涉及范围更广泛，诊治面临更大挑战。本文将结合国内诊治现状，梳理儿童自身免疫性脑炎诊治流程，并对当今存在的主要的诊治误区进行解读和分析，旨在帮助广大儿科医师提升自身免疫性脑炎的精准诊治水平。

关键词: 自身免疫性脑炎, 诊断, 治疗, 儿童

Abstract:

Over the past 15 years, the development of antibody detection technology led to the increased awareness of autoimmune encephalitis. However, the innovation has also brought about a certain proportion of misdiagnosis, and some patients have been treated improperly as a result. The main reasons for misdiagnosis include lax implementation of diagnostic criteria, incorrect interpretation of antibody test results, and insufficient differential diagnosis. Compared with adults, the symptoms of children with autoimmune encephalitis are more difficult to identify, and there are antibody spectrum and characteristics that are different from those of adults. The differential diagnosis of the disease involves a wider range, and its diagnosis and treatment face greater challenges. This article will summarize the diagnosis and treatment process of autoimmune encephalitis in children based on the current situation in China. The related pitfalls of diagnosis and treatment are interpreted and analyzed in order to help pediatricians improve accurate diagnosis and treatment of autoimmune encephalitis.

Key words: autoimmune encephalitis, diagnosis, therapy, child

张炜华, 邹丽萍, 任海涛, 关鸿志. 警惕儿童自身免疫性脑炎诊治陷阱[J]. 临床儿科杂志, 2023, 41(9): 644-649.

ZHANG Weihua, ZOU Liping, REN Haitao, GUAN Hongzhi. Beware of the pitfalls in diagnosis and treatment of autoimmune encephalitis in children[J]. Journal of Clinical Pediatrics, 2023, 41(9): 644-649.

图/表 2

参考文献 22

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广义免疫机制相关CNS炎症	①系统性疾病CNS受累：如SLE、BD
	②感染相关急性脑病
	③发热感染相关癫痫综合征（FIRES）
	④CNS血管炎（原发、继发）
	⑤CNS炎性脱髓鞘疾病
中枢神经系统感染	①病毒：HSV1/2、VZV、CMV
	②其他：细菌、支原体、结核、真菌
遗传	①炎症：自身炎症性疾病（AGS、DADA2），家族性噬血细胞综合征
	②代谢：高氨血症、甲基丙二酸血症合并高同型半胱氨酸血症、卟啉病、线粒体病等
	③离子通道病：ATP1A2、ATP1A3、CACNA1A等
营养或中毒	①药物或毒物：甲硝唑、环孢素、精神类药物、毒品等
	②维生素缺乏：韦尼克脑病、维生素B₁₂缺乏等
其他	①精神类疾病：精神分裂症、癔症、双相情感障碍、孤独症等
	②肿瘤：脑膜癌、胶质瘤、生殖细胞瘤等
	③儿童虐待

警惕儿童自身免疫性脑炎诊治陷阱

Beware of the pitfalls in diagnosis and treatment of autoimmune encephalitis in children

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