警惕儿童自身免疫性脑炎诊治陷阱

张炜华; 邹丽萍; 任海涛; 关鸿志

doi:10.12372/jcp.2023.23e0455

临床儿科杂志 >

2023 , Vol. 41 >Issue 9: 644 - 649

DOI: https://doi.org/10.12372/jcp.2023.23e0455

专家笔谈

警惕儿童自身免疫性脑炎诊治陷阱

张炜华 ,
邹丽萍 ,
任海涛 ,
关鸿志

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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

网络出版日期: 2023-09-05

基金资助

河南省儿童神经发育工程研究中心开放课题(SG202203)

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

Weihua ZHANG ,
Liping ZOU ,
Haitao REN ,
Hongzhi GUAN

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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 date: 2022-11-29

Online published: 2023-09-05

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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

本文引用格式

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 . DOI: 10.12372/jcp.2023.23e0455

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

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