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张慧琼,张宇昕,胡燕,郑贵浪,郭予雄,翟琼香*.单纯疱疹病毒脑炎继发抗N-甲基-D-天冬氨酸受体脑炎患儿3例临床分析[J].Academic Journal of Second Military Medical University ,2021,42(9):1067-1071
单纯疱疹病毒脑炎继发抗N-甲基-D-天冬氨酸受体脑炎患儿3例临床分析    点此下载全文 Fulltext
张慧琼  张宇昕  胡燕  郑贵浪  郭予雄  翟琼香*
广东省人民医院(广东省医学科学院)
儿科, 广州 510080
*通信作者
基金项目:
DOI:10.16781/j.0258-879x.2021.09.1067
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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  N-甲基-D-天冬氨酸受体脑炎  临床特点  治疗  预后
Herpes simplex virus encephalitis-induced anti-N-methyl-D-aspartate receptor encephalitis in children: a clinical analysis of 3 cases    Fulltext
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
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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.
Keywords:herpes simplex encephalitis  anti-N-methyl-D-aspartate receptor encephalitis  clinical characteristics  treatment  prognosis
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