儿童自身免疫性脑炎合并运动障碍的临床特征及预后分析：一项单中心回顾性研究

doi:10.12372/jcp.2026.25e0962

临床儿科杂志 ›› 2026, Vol. 44 ›› Issue (6): 532-539.doi: 10.12372/jcp.2026.25e0962

儿童自身免疫性脑炎合并运动障碍的临床特征及预后分析：一项单中心回顾性研究

石永媛¹^,², 杨丽娟¹^,², 雷文婷¹, 熊玉蓉¹, 潘书静¹, 李跃林¹, 张佳丽¹, 田茂强¹()

¹ 遵义医科大学附属医院小儿内科/贵州省儿童医院小儿内科（贵州遵义 563003）
² 浙江省人民医院毕节医院儿科（贵州毕节 551700）

收稿日期:2025-08-07 修回日期:2025-11-17 录用日期:2025-12-04 出版日期:2026-06-15 发布日期:2026-06-04
通讯作者: 田茂强 E-mail:drmaoqiang@126.com
作者简介:第一联系人：作者贡献（Authors’ Contributions）
石永媛负责研究设计，收集整理数据、随访病例，撰写论文；杨丽娟、雷文婷负责收集数据、随访病例；熊玉蓉、潘书静整理、分析数据；李跃林、张佳丽负责图表设计；田茂强全面负责研究的设计和实施、数据分析、论文修改。

Clinical characteristics and prognosis analysis of autoimmune encephalitis with movement disorders in children: A single-center retrospective study

SHI Yongyuan¹^,², YANG Lijuan¹^,², LEI Wenting¹, XIONG Yurong¹, PAN Shujing¹, LI Yuelin¹, ZHANG Jiali¹, TIAN Maoqiang¹()

¹ Department of Pediatrics, Guizhou Children's Hospital/Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou, China
² Department of Pediatrics, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie 551700, Guizhou, China

Received:2025-08-07 Revised:2025-11-17 Accepted:2025-12-04 Published:2026-06-15 Online:2026-06-04
Contact: TIAN Maoqiang E-mail:drmaoqiang@126.com

摘要/Abstract

摘要：

目的运动障碍是儿童自身免疫性脑炎（AE）并不少见的临床表现，儿童AE患者中运动障碍的发病特征以及运动障碍对AE临床预后的影响尚有待系统阐明。本研究旨在通过对单中心10年积累患儿的系统回顾，研究上述问题。方法回顾性分析2014年1月至2023年12月确诊为AE的82例患儿资料，收集其一般情况、临床表现、实验室检查、治疗及预后等信息，采用改良Rankin量表（mRS）评估病情严重程度，并比较不同年龄组间的差异。结果患儿中位发病年龄为9（1.2~17）岁，46.3%抗神经元抗体阳性，其中抗NMDAR脑炎占39.0%。最常见症状为精神行为异常、运动障碍和癫痫发作。运动障碍发生率为68.3%，以刻板运动和口面部运动障碍为主，抗NMDAR脑炎患儿运动障碍发生率更高（81.3%）。年龄分层显示，<12岁组运动障碍更常见（P<0.05），口面部运动障碍在该组尤为突出（P=0.027），且仅见于该组抗NMDAR脑炎患儿（P=0.004）。运动障碍组自主神经功能紊乱、睡眠障碍、抗NMDAR抗体阳性比例及mRS评分均高于非运动障碍组（P<0.05）。总体预后良好率为70.7%，复发率为11.0%；除了运动障碍组出院时mRS评分高于非运动障碍组（P=0.027），两组患儿的其他远期预后指标未观察到差异。结论儿童AE患者的抗体阳性率不足50%，临床表现以精神行为异常、运动障碍和癫痫发作为主，运动障碍多见于<12岁患儿及抗NMDAR脑炎患者，存在自主神经功能紊乱及睡眠障碍的患儿更容易合并运动障碍；运动障碍并不是AE儿童预后不良的危险因素。

关键词: 自身免疫性脑炎, 抗N-甲基-D-天冬氨酸受体, 运动障碍, 儿童

Abstract:

Objective Movement disorders are not uncommon clinical manifestations in children with autoimmune encephalitis (AE). The characteristics of movement disorders in children with AE and their impact on the clinical prognosis of AE remain to be systematically clarified. This study aims to investigate these issues through a systematic review of patients accumulated over 10 years in a single center. Methods A retrospective analysis was conducted on the data of 82 children diagnosed with AE from January 2014 to December 2023. Information on their general conditions, clinical manifestations, laboratory tests, treatments, and prognoses was collected. The modified Rankin Scale (mRS) was used to assess the severity of the disease, and differences between different age groups were compared. Results The median age of onset was 9 (1.2 - 17) years, and 46.3% were positive for anti-neuronal antibodies, with anti-NMDAR encephalitis accounting for 39.0%. The most common symptoms were behavioral abnormalities, movement disorders, and epileptic seizures. The incidence of movement disorders was 68.3%, mainly characterized by stereotyped movements and orofacial movement disorders. The incidence of movement disorders was higher in children with anti-NMDAR encephalitis (81.3%). Age stratification showed that movement disorders were more common in the <12-year-old group (P<0.05), and orofacial movement disorders were particularly prominent in this group (P=0.027), and were only observed in children with anti-NMDAR encephalitis in this group (P=0.004). The proportion of autonomic dysfunction, sleep disorders, anti-NMDAR antibody positivity, and mRS scores in the movement disorder group were all higher than those in the non-movement disorder group (P<0.05). The overall good prognosis rate was 70.7%, and the recurrence rate was 11.0%. Except for the mRS score at discharge being higher in the movement disorder group than in the non-movement disorder group (P=0.027), no differences were observed in other long-term prognosis indicators between the two groups. Conclusion The antibody positivity rate in children with AE is less than 50%, and the clinical manifestations are mainly behavioral abnormalities, movement disorders, and epileptic seizures. Movement disorders are more common in children under 12 years old and those with anti-NMDAR encephalitis. Patients with autonomic dysfunction and sleep disorders are more likely to have movement disorders. Movement disorders are not a risk factor for poor prognosis in children with AE.

Key words: autoimmune encephalitis, anti-NMDAR encephalitis, movement disorders, child

中图分类号:

石永媛, 杨丽娟, 雷文婷, 熊玉蓉, 潘书静, 李跃林, 张佳丽, 田茂强. 儿童自身免疫性脑炎合并运动障碍的临床特征及预后分析：一项单中心回顾性研究[J]. 临床儿科杂志, 2026, 44(6): 532-539.

SHI Yongyuan, YANG Lijuan, LEI Wenting, XIONG Yurong, PAN Shujing, LI Yuelin, ZHANG Jiali, TIAN Maoqiang. Clinical characteristics and prognosis analysis of autoimmune encephalitis with movement disorders in children: A single-center retrospective study[J]. Journal of Clinical Pediatrics, 2026, 44(6): 532-539.

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项目	运动障碍组（n=56）	无运动障碍组（n=26）	统计量	P
年龄[M(P₂₅~P₇₅)]/岁	8(4~11)	12.5(4~14.5)	Z=1.78	0.075
男性[n(%)]	25(44.6)	14(53.8)	χ²=0.60	0.437
住院时长[M(P₂₅~P₇₅)]/d	20.00(14.00~26.5)	17.5(12.75~22.25)	Z=1.42	0.155
急性或亚急性起病[n(%)]	53(94.6)	25(96.2)	χ²=0.00	1.000
呕吐[n(%)]	2(3.6)	0(0.0)	-	1.000^1）
头晕/头痛[n(%)]	4(7.1)	6(23.1)	χ²=2.85	0.091
精神行为异常[n(%)]	41(73.2)	16(61.5)	χ²=1.14	0.285
认知障碍[n(%)]	17(30.4)	4(15.4)	χ²=2.09	0.148
记忆障碍[n(%)]	8(14.3)	6(23.1)	χ²=0.45	0.503
癫痫发作[n(%)]	35(62.5)	18(69.2)	χ²=0.35	0.553
癫痫持续状态[n(%)]	9(16.1)	3(11.5)	χ²=0.04	0.838
语言障碍[n(%)]	18(32.1)	4(15.4)	χ²=2.54	0.111
意识障碍[n(%)]	15(26.8)	4(15.4)	χ²=1.30	0.255
自主神经功能障碍[n(%)]	20(35.7)	3(11.5)	χ²=5.14	0.023
睡眠障碍[n(%)]	35(62.5)	10(38.5)	χ²=4.14	0.042
阳性体征[n(%)]	12(21.4)	3(11.5)	χ²=0.60	0.441
并发症[M(P₂₅~P₇₅)]/个	1(0~3)	1(0~2)	Z=0.32	0.749
治疗前mRS评分[M(P₂₅~P₇₅)]	4(3~4.75)	3(3~4.25)	Z=2.25	0.025

项目	运动障碍组（n=56）	无运动障碍组（n=26）	统计量	P
外周血白细胞[M(P₂₅~P₇₅)]/×10⁹·L^-1	8.47(6.20~11.33)	6.85(5.69~10.69)	Z=1.11	0.267
外周血血红蛋白（ x±s）/g·L^-1	122.70±15.34	122.38±13.18	t=0.09	0.929
外周血血小板（ x±s）/×10⁹·L^-1	322.88±118.59	326.27±109.24	t=0.12	0.902
外周血中性粒细胞[M(P₂₅~P₇₅)]/×10⁹·L^-1	5.24(3.92~7.97)	4.74(3.10~7.20)	Z=1.04	0.298
外周血淋巴细胞[M(P₂₅~P₇₅)]/×10⁹·L^-1	1.93(1.45~2.91)	1.94(0.96~2.44)	Z=1.12	0.262
血钾（ x±s）/mmol·L^-1	4.14±0.46	4.14±0.52	t=0.05	0.961
血钠（ x±s）/mmol·L^-1	137.49±2.64	136.94±3.10	t=0.84	0.404
丙氨酸氨基转移酶[M(P₂₅~P₇₅)]/U·L^-1	16.50(12.00~30.25)	19.00(9.75~28.50)	Z=0.39	0.694
肌酸激酶同工酶[M(P₂₅~P₇₅)]/U·L^-1	19.0(14.00~24.00)	19.0(15.00~22.00)	Z=0.37	0.712
脑脊液压力≥200 mmH₂O[n(%)]	13(23.2)	8(30.8)	χ²=0.53	0.466
脑脊液白细胞[M(P₂₅~P₇₅)]/×10⁶·L^-1	11.00(1.25~32.75)	8.00(2.00~14.75)	Z=0.74	0.457
脑脊液蛋白质[M(P₂₅~P₇₅)]/mg·L^-1	295.50(198.00~365.75)	295.50(244.00~397.50)	Z=0.52	0.517
脑脊液葡萄糖（ x±s）/mmol·L^-1	3.62±0.54	3.96±0.62	t=2.55	0.013
脑脊液氯化物（ x±s）/mmol·L^-1	125.85±4.03	125.82±2.91	t=0.03	0.977
抗NMDAR抗体阳性[n(%)]	26(46.4)	6(23.1)	χ²=4.07	0.044
头颅MRI异常[n(%)]	27(48.2)	11(42.3)	χ²=0.25	0.618
脑电图异常[n(%)]	45(80.4)	22(84.6)	χ²=0.03	0.875

项目	运动障碍组（n=56）	无运动障碍组（n=26）	统计量	P
免疫延迟治疗[n(%)]	10(17.9)	4(15.4)	χ²=0.00	1.000
二线治疗[n(%)]	9(16.1)	3(11.5)	χ²=0.04	0.838
气管插管[n(%)]	7(12.5)	8(30.8)	χ²=2.84	0.092
出院时mRS评分[M(P₂₅~P₇₅)]	2.00(1.00~3.75)	1.00(1.00~2.00)	Z=2.21	0.027
随访时mRS评分[M(P₂₅~P₇₅)]	0.00(0.00~2.00)	0.00(0.00~2.00)	Z=0.31	0.757
预后不良[n(%)]	16(28.6)	8(30.8)	χ²=0.04	0.839
复发[n(%)]	7(12.5)	2(7.7)	χ²=0.07	0.788

儿童自身免疫性脑炎合并运动障碍的临床特征及预后分析：一项单中心回顾性研究

Clinical characteristics and prognosis analysis of autoimmune encephalitis with movement disorders in children: A single-center retrospective study

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