卵巢畸胎瘤合并自身免疫性脑炎救治1例报道

李美 玉1, 郑寰 宇2, 邓彩 凤1, 褚丽 娜2
1.华北理工大学研究生院 河北唐山 06300； 2.唐山工人医院 河北唐山 063000

摘要

目的：卵巢畸胎瘤合并自身免疫性脑炎是以精神神经为首发表现的疾病，妇科方面的症状容易被忽略。方法：通过对国内外现有的文献详细地回顾复习并通过本院收治的1例严重案例的临床资料来全面阐述。结果：本报道患者出现了癫痫大发作、神志不清伴四肢僵硬等症状，予以免疫治疗后行卵巢畸胎瘤切除术，术后继续免疫治疗，患者整体恢复良好。结论：卵巢畸胎瘤合并抗NMDAR脑炎如无手术禁忌症应尽早完成手术治疗，术后患者意识障碍、精神行为异常等症状有很大改善，结合免疫疗法多数患者有良好预后。

关键词

自身免疫性脑炎；卵巢畸胎瘤

参考

[1]邵龙,王威,郑娜,蒋胶胶,张家堂.自身免疫性脑炎治疗进展[J].解放军医学杂志,2017,42(04):347-353.[2]Dalmau J,Tüzün E,Wu HY,et al.Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol.2007;61(1):25-36.doi:10.1002/ana.21050[3]Graus F,Titulaer MJ,Balu R,et al.A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol.2016;15(4):391-404.doi:10.1016/S1474-4422(15)00401-9[4]Dutta A,Krieger J,Lee JY,Garcia-Nafria J,Greger IH,Bahar I.Cooperative Dynamics of Intact AMPA and NMDA Glutamate Receptors:Similarities and Subfamily-Specific Differences. Structure.2015;23(9):1692-1704. doi:10.1016/j.str.2015.07.002[5]Mangler M,Trebesch de Perez I,Teegen B,et al.Seroprevalence of anti-N-methyl-D-aspartate receptor antibodies in women with ovarian teratoma. J Neurol.2013;260(11):2831-2835.doi:10.1007/s00415-013-7074-0[6]王观凤,郑丽娇,黄洁,彭冬先.NMDA受体在抗NMDA受体脑炎患者卵巢畸胎瘤组织中的表达特点及意义[J].实用医学杂志,2019,35(09):1458-1461.[7]Bravo-Oro A, Acosta-Yebra D,Grimaldo-Zapata IP,Reyes-Vaca G.Atrofia cortical reversible secundaria a encefalitis por anticuerpos antirreceptor de NMDA[Reversible corticalatrophy secondary to anti-NMDA receptor antibody encephalitis].Rev Neurol.2015;60(10):447-452.[8]Dalmau J,Lancaster E,Martinez-Hernandez E,Rosenfeld MR,Balice-Gordon R.Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis.Lancet Neurol.2011;10(1):63-74.doi:10.1016/S1474-4422(10)70253-2[9]Dalmau J,Lancaster E,Martinez-Hernandez E,Rosenfeld MR,Balice-Gordon R.Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis.Lancet Neurol.2011;10(1):63-74.doi:10.1016/S1474-4422(10)70253-2[10]Dalmau J,Lancaster E,Martinez-Hernandez E,Rosenfeld MR,Balice-Gordon R.Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis.Lancet Neurol.2011;10(1):63-74.doi:10.1016/S1474-4422(10)70253-2[11]Zhang L,Wu MQ,Hao ZL, et al. Clinical characteristics, treatments, and outcomes of patients with anti-N-methyl-d-aspartate receptor encephalitis: A systematic review of reported cases. Epilepsy Behav. 2017;68:57-65. doi:10.1016/j.yebeh.2016.12.019