| 摘要: |
| 目的 分析儿童单纯疱疹病毒脑炎继发抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎的临床特点、治疗及转归情况。方法 收集我科收治的3例单纯疱疹病毒脑炎继发抗NMDAR脑炎患儿临床资料，其中男2例、女1例，年龄分别为1岁9个月、10岁和4岁。结果 3例患儿均表现为抽搐起病，伴意识改变、行为异常，脑脊液单纯疱疹病毒Ⅰ型均为阳性。3例患儿予抗病毒及对症处理后病情均有好转，但分别于病程1周至1个月后病情再次加重，脑脊液NMDAR抗体均呈阳性。经积极对症治疗后，2例患儿恢复较好，1例放弃治疗后死亡。结论 单纯疱疹病毒脑炎可发展至抗NMDAR脑炎，动态检测NMDAR抗体有助于早期识别单纯疱疹病毒脑炎后自身免疫性脑炎的发生，从而进行早期干预。 |
| 关键词: 单纯疱疹脑炎 抗N-甲基-D-天冬氨酸受体脑炎 临床特点 治疗 预后 |
| DOI：10.16781/j.0258-879x.2021.09.1067 |
| 投稿时间：2020-05-19修订日期：2020-12-18 |
| 基金项目: |
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| Herpes simplex virus encephalitis-induced anti-N-methyl-D-aspartate receptor encephalitis in children: a clinical analysis of 3 cases |
| ZHANG Hui-qiong,ZHANG Yu-xin,HU Yan,ZHENG Gui-lang,GUO Yu-xiong,ZHAI Qiong-xiang* |
(Department of Paediatrics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, Guangdong, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the clinical characteristics, treatment and outcomes of herpes simplex virus encephalitis-induced anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis in children. Methods The clinical data of 3 children with herpes simplex virus encephalitis-induced anti-NMDAR encephalitis treated in our department were collected, including 2 males and 1 female, aged 21 months, 10 years and 4 years, respectively. Results All the 3 children began with convulsion, accompanied by altered consciousness and abnormal behavior. Herpes simplex virus typeⅠ in cerebrospinal fluid was tested positive in all 3 cases. After antiviral and symptomatic treatment, the condition of 3 children was improved, but was aggravated again after 1 week to 1 month, with positive cerebrospinal fluid anti-NMDAR antibodies. After active symptomatic treatment, 2 children recovered well, and 1 gave up treatment and died. Conclusion Herpes simplex virus encephalitis can develop anti-NMDAR encephalitis. Dynamic detection of anti-NMDAR antibody is helpful to early identify the occurrence of autoimmune encephalitis after herpes simplex virus encephalitis, so as to intervene early. |
| Key words: herpes simplex encephalitis anti-N-methyl-D-aspartate receptor encephalitis clinical characteristics treatment prognosis |
