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目的探讨N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)抗体水平在抗NMDAR脑炎和病毒性脑炎的鉴别诊断及病情评估中的作用。方法选择2014年3月至2016年3月住院治疗的抗NMDAR脑炎患者53例为研究组,同期病毒性脑炎患者22例作为对照组。对两组患者的临床资料及血清、脑脊液的NMDAR抗体水平进行分析。结果抗NMDAR脑炎相比病毒性脑炎患者临床表现发生率存在统计学差异:有前驱感染史(χ~2=11.54,P=0.00)、发热(χ~2=16.31,P=0.00)、意识障碍(χ~2=9.02,P=0.00)、癫痫发作(χ~2=19.67,P=0.00)、不自主运动(χ~2=6.82,P=0.00)。抗NMDAR脑炎组(t=11.39,P=0.00)和病毒性脑炎组(t=10.91,P=0.00)NMDAR抗体在脑脊液中含量均显著高于血清中含量;且抗NMDAR脑炎组NMDAR抗体在血清(t=7.95,P=0.00)、脑脊液(t=16.46,P=0.00)中含量均高于病毒性脑炎组;抗NMDAR脑炎重症和普通型患者NMDAR抗体高水平者发生率在血清(χ~2=22.80,P=0.00)、脑脊液(χ~2=27.75,P=0.00)中均高于普通型患者。结论抗NMDAR脑炎和病毒性脑炎患者在临床表现上存在一定差别,血清、脑脊液中NMDAR抗体水平可作为鉴别诊断、病情评估的主要指标。
Objective To investigate the role of N-methyl-D-aspartate receptor (NMDAR) antibody in the differential diagnosis and evaluation of anti-NMDAR encephalitis and viral encephalitis. Methods 53 cases of hospitalized anti-NMDAR encephalitis from March 2014 to March 2016 were selected as the study group, while 22 cases of viral encephalitis were used as the control group. The clinical data of two groups of patients and serum and cerebrospinal fluid NMDAR antibody levels were analyzed. Results The incidence of anti-NMDAR encephalitis in patients with viral encephalitis was significantly different from that of patients with viral encephalitis (P <0.01) The disturbance of consciousness (χ ~ 2 = 9.02, P = 0.00), seizures (χ ~ 2 = 19.67, P = 0.00) and involuntary movements (χ ~ 2 = 6.82, P = 0.00). NMDAR antibody levels in the cerebrospinal fluid (CSF) were significantly higher than those in the NMDAR encephalitis group (t = 11.39, P = 0.00) and viral encephalitis group (t = 10.91, P = 0.00) The antibody levels in serum (t = 7.95, P = 0.00) and CSF (t = 16.46, P = 0.00) were higher than those in viral encephalitis group. The incidence of NMDAR antibody in patients with severe and common type of NMDAR encephalitis was significantly higher Serum (χ ~ 2 = 22.80, P = 0.00), cerebrospinal fluid (χ ~ 2 = 27.75, P = 0.00) were higher than the average type of patients. Conclusion The clinical manifestations of anti-NMDAR encephalitis and viral encephalitis are different. The level of NMDAR antibody in serum and cerebrospinal fluid can be used as the main index for differential diagnosis and disease evaluation.