| objectiveIn this paper,13 cases of autoimmune encephalitis(Autoimmune encephalitis,AE)clinical data of patients with clinical manifestations,blood biochemical,immune index,tumor screening,cerebrospinal fluid examination,EEG,brain MRI,treatment and curative effect and follow-up results were analyzed,and combined with related literature,a comprehensive discussion of pathological and physiological characteristics,various types of autoimmune encephalitis in patients with clinical manifestations,laboratory examination,imaging examination,treatment and prognosis,and provide reference for clinical diagnosis and treatment.Materials and methodsThis study collected during the period from July 2014 to October 2016,in the treatment of hospitalized patients in neurology department of the Second Affiliated Hospital of Nanchang University,at the end of the 13 AE patients were collected,the general data,clinical manifestations,blood biochemical,immune index,tumor screening,cerebrospinal fluid examination,EEG,brain MRI,treatment and curative effect and follow-up results.The data of 13 patients with AE were retrospectively analyzed.Frequency and percentage were used to describe the specific situation of each patient,and the characteristics of each type of AE were analyzed.ResultCollect consistent performance and encephalitis in serum and(or)to patients with anti cell surface antigen antibody and anti intracellular antigen antibody to detect13 cases of cerebrospinal fluid,the anti N with a total of D with methyl aspartate receptor(NMDAR)encephalitis in 6 cases,anti y-aminobutyric acid B receptor(GABABR)in 4 cases of encephalitis,anti Fu leucine rich glioma inactivated protein1(Leucine-rich glioma inactivated L,LGll)1 cases of encephalitis,antiAmphiphysin antibody in 1 cases of encephalitis,1 cases of anti Ma2 encephalitis.There were 8 male patients and 5 female patients(aged from 25 to 87 years).The main clinical manifestations of patients with epilepsy,cognitive dysfunction,mental and behavioral abnormalities,memory decline.13 cases of patients with AE antibody detection,including 4 cases of cerebrospinal fluid and serum antibodies were positive,only cerebrospinal fluid antibody positive in 6 cases,only positive for serum antibody in 3 patients.Serum electrolytes,liver and kidney function tests showed that 5 cases showed abnormal electrolyte,in which,in the other group,hypokalemia was found in the 2 patients,hyponatremia and hypokalemia in the 3 cases,abnormal renal function in the 1 cases,and abnormal liver function in 3 cases.4 cases of abnormal thyroid function;detection of 4 cases of thyroid hormone antibodies,of which 2 cases showed: thyroglobulin antibody increased;for patients with rheumatic immune function of four,six,ANA ANA3,ANCA spectrum,immune index inspection found that the relevant indexes of 5 cases were found abnormal in 3 cases,the serum decreased 3 patients with positive antinuclear antibody,anti Ro-52 antibody positive in 2 cases,1 cases of anti CENP B antibody positive,1 cases of anti cytoplasmic antibody positive,1 cases of positive anti SS-A antibody.Four tumor detection showed that serum tumor markers increased in 3 cases.Cerebrospinal fluid pressure,cerebrospinal fluid routine,biochemical tests showed: 3 patients with elevated cerebrospinal fluid pressure,white blood cells increased in 7 cases,abnormal protein in the 7 cases,of which,in the case of the protein decreased in 1 cases,in which the protein was increased in 6 cases.6 patients underwent EEG examination,4 cases showed abnormal,1 cases of left frontal temporal epileptiform discharge,3 cases showed slow wave.Abnormal cranial MRI in 11 cases,respectively,in the hippocampus,lateral ventricle,three ventricle,pons,temporal lobe,frontal lobe,caudate nucleus,lentiform nucleus,cerebellum,occipital lobe,parietal lobe and the abnormal signal,2 cases showed no abnormal.For patients with abdominal ultrasound,chest,abdomen,pelvic CT,male urinary tract ultrasonography,perfect female gynecological ultrasound,including 1 patients with two lower lobe atelectasis limitations,multiple mediastinal lymph nodes,bilateral pleural effusion,I found no obvious signs of malignancy.10 patients used immunosuppressive therapy,mainlycorticosteroids and intravenous immunoglobulin(Intravenous,immunoglobulin,IVIG),most of the patients,the follow-up results showed that 4 cases recovered,2cases showed 1 cases of memory loss,cognitive function decline,1 cases still had partial seizures,1 cases of lung cancer are to be found,chemotherapy,2 cases of death.conclusionTo sum up,although the sample size is small,we can still find the characteristic expression.The AE patients are more prone to male patients than female patients,and the median age is high,the difference is statistically significant,further research in this study;clinical manifestations of patients with reported consistent performance for epilepsy,cognitive dysfunction,mental and behavioral abnormality,and half of the patients can be accompanied by headache,fever and other symptoms of precursor.Secondary examinations can help to eliminate rheumatic and neoplastic diseases.If critically ill patients are accompanied by hypothyroidism,the prognosis is often poor.It was found that the sensitivity and specificity of cerebrospinal fluid antibody test in anti neuron surface antibody encephalitis were often higher.EEG examination and most of the abnormal manifestations of brain MRI,but there is no obvious specificity,and the performance of limbic encephalitis clinical manifestations,patients with abnormal brain MRI signals can occur outside the limbic system.The treatment of AE is mainly controlled by immunosuppressive therapy,and the prognosis is good by standardized immunotherapy.In 2016 China’s autoimmune encephalitis guidelines only anti NMDAR encephalitis patients treatment process,but for other patients with encephalitis as first-line treatment of the combined therapy is better prognosis than single use,and the antibody titer change is of guiding significance to the prognosis,need further clinical research.There is a tendency of recurrence in AE patients.Immunosuppressive therapy with enough time may reduce its recurrence.It is necessary to do follow-up and regular outpatient review. |
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