论著

儿童抗N-甲基-D-天冬氨酸受体脑炎前驱事件与临床特征相关性分析

  • 吴汶霖 ,
  • 侯池 ,
  • 郑可鲁 ,
  • 张雅妮 ,
  • 曾意茹 ,
  • 陈连凤 ,
  • 朱海霞 ,
  • 田杨 ,
  • 彭炳蔚 ,
  • 王秀英 ,
  • 廖寅婷 ,
  • 陈文雄 ,
  • 李小晶
展开
  • 广州市妇女儿童医疗中心神经内科(广东广州 510120)

收稿日期: 2023-10-20

  网络出版日期: 2024-11-08

Analysis of prodromal events in pediatric patients with anti-N-methyl-D-aspartate receptor encephalitis

  • Wenlin WU ,
  • Chi HOU ,
  • Kelu ZHENG ,
  • Yani ZHANG ,
  • Yiru ZENG ,
  • Lianfeng CHEN ,
  • Haixia ZHU ,
  • Yang TIAN ,
  • Bingwei PENG ,
  • Xiuying WANG ,
  • Yinting LIAO ,
  • Wenxiong CHEN ,
  • Xiaojing LI
Expand
  • Department of Neurology, Guangzhou Women and Children’s Medical Center, Guangzhou 510120, Guangdong, China

Received date: 2023-10-20

  Online published: 2024-11-08

摘要

目的 分析儿童抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎前驱事件与临床特征之间的相关性。方法 回顾性分析自2014年1月至2019年3月间就诊的107例抗NMDAR脑炎的患儿前驱事件与临床特征。结果 107例患儿中,52例(48.6%)患儿存在前驱事件,其中以感染性前驱事件为主(73.1%,38/52)。通过比较有无前驱事件患儿间临床特点,发现存在颅内感染前驱事件患儿比无颅内感染前驱事件患儿的发病年龄小(P=0.006),且出现肢体瘫痪(P=0.038)和睡眠障碍(P=0.037)的占比更高。另外,存在颅内感染前驱事件患儿的住院天数长于无颅内感染前驱期事件的患儿(P=0.001),且治疗前改良Rankin评分更高(P=0.008),所需的免疫球蛋白疗程次数也更多(P=0.011)。结论 存在前驱事件的抗NMDAR脑炎患儿呈现出部分不同的临床特征。与无颅内感染前驱事件患儿相比,存在颅内感染前驱事件的患儿发病年龄更小,并更易出现肢体瘫痪、睡眠障碍和更高的治疗前改良Rankin评分,需要更长的住院天数和更多免疫球蛋白治疗疗程。

本文引用格式

吴汶霖 , 侯池 , 郑可鲁 , 张雅妮 , 曾意茹 , 陈连凤 , 朱海霞 , 田杨 , 彭炳蔚 , 王秀英 , 廖寅婷 , 陈文雄 , 李小晶 . 儿童抗N-甲基-D-天冬氨酸受体脑炎前驱事件与临床特征相关性分析[J]. 临床儿科杂志, 2024 , 42(11) : 912 -916 . DOI: 10.12372/jcp.2024.23e1027

Abstract

Objective To analyze the correlation between anti N-methyl-D-aspartate receptor (NMDAR) encephalitis prodromal events and clinical features in children. Methods A retrospective analysis was conducted on 107 pediatric patients with anti-NMDAR encephalitis from January 2014 to March 2019, to examine the correlation between prodromal events and clinical characteristics in these children. Results Of the 107 patients, 52 cases (48.6%) had prodromal events, predominantly consisting of infectious prodromal events (73.1%, 38 out of 52). A comparative analysis revealed that patients with a history of intracranial infection as a prodromal event were significantly younger at onset (6.0±4.7 years) compared to those without such a history (6.4±2.9 years, P=0.006). Additionally, these patients had a markedly higher incidence of limb paralysis (P=0.038) and sleep disorders (P=0.037). The hospital stay was prolonged for patients with intracranial infection prodromal events (P=0.001). Furthermore, these patients exhibited higher modified Rankin Scale (mRS) scores prior to treatment (P=0.008) and required more courses of intravenous immunoglobulin (IVIG) treatment (P=0.011). Conclusions Pediatric patients with anti-NMDAR encephalitis and prodromal events, particularly those with intracranial infections, displayed distinct clinical profiles. They were more likely to present at an earlier age with increased rates of limb paralysis and sleep disorders, necessitating longer hospital stays and additional IVIG treatments.

参考文献

[1] 中华医学会神经病学分会神经感染性疾病与脑脊液细胞学学组. 中国自身免疫性脑炎诊治专家共识(2022年版)[J]. 中华神经科杂志, 2022, 55(9): 931-949.
[2] Jiang Y, Dai S, Jia L, et al. Single-cell transcriptomics reveals cell type-specific immune regulation associated with anti-NMDA receptor encephalitis in humans[J]. Front Immunol, 2022, 13: 1075675.
[3] Sun B, Ramberger M, O'Connor KC, et al. The B cell immunobiology that underlies CNS autoantibody-mediated diseases[J]. Nat Rev Neurol, 2020, 16(9): 481-492.
[4] Wang Y, Zhang W, Yin J, et al. Anti-N-methyl-D-aspartate receptor encephalitis in children of Central South China: Clinical features, treatment, influencing factors, and outcomes[J]. J Neuroimmunol, 2017, 312: 59-65.
[5] Li X, Hou C, Wu WL, et al. Pediatric anti-N-methyl-D-aspartate receptor encephalitis in southern China: Analysis of 111 cases[J]. J Neuroimmunol, 2021, 352: 577479.
[6] Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis[J]. Lancet Neurol, 2011, 10(1): 63-74.
[7] Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis[J]. Lancet Neurol, 2016, 15(4): 391-404.
[8] 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.
[9] Wang W, Li JM, Hu FY, et al. Anti-NMDA receptor encephalitis: clinical characteristics, predictors of outcome and the knowledge gap in southwest China[J]. Eur J Neurol, 2016, 23(3): 621-629.
[10] Huang Q, Wu Y, Qin R, et al. Clinical characteristics and outcomes between children and adults with anti-N-Methyl-D-Aspartate receptor encephalitis[J]. J Neurol, 2016, 263(12): 2446-2455.
[11] Armangue T, Spatola M, Vlagea A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis[J]. Lancet Neurol, 2018, 17(9): 760-772.
[12] Favier M, Joubert B, Picard G, et al. Initial clinical presentation of young children with N-methyl-D-aspartate receptor encephalitis[J]. Eur J Paediatr Neurol, 2018, 22(3): 404-411.
[13] Ho AC, Chan SH, Chan E, et al. Anti-N-methyl-D-aspartate receptor encephalitis in children: Incidence and experience in Hong Kong[J]. Brain Dev, 2018, 40(6): 473-479.
[14] Lee SH, Atiya N, Wang SM, et al. Loss of transfected human brain micro-vascular endothelial cell integrity during herpes simplex virus infection[J]. Intervirology, 2018, 61(4): 193-203.
[15] Dalmau J. NMDA receptor encephalitis and other antibody-mediated disorders of the synapse: The 2016 Cotzias Lecture[J]. Neurology, 2016, 87(23): 2471-2482.
[16] Stahl JP, Mailles A. Herpes simplex virus encephalitis update[J]. Curr Opin Infect Dis, 2019, 32(3): 239-243.
[17] Wang H. A protocol for investigating the association of vaccination and anti-NMDA receptor encephalitis[J]. Front Biosci (Schol Ed), 2018, 10(2): 229-237.
文章导航

/