摘要目的 探讨静脉输注人免疫球蛋白(WIG)治疗抗N-甲基-D-门冬氨酸(NMDA)受体脑炎的疗效和安全性.方法 对2012年1月至2014年12月收入首都医科大学宣武医院神经内科的抗NMDA受体脑炎、首次接受IVIG治疗[0.4g/(b·d),1次/d,连续5d]患者进行回顾性研究.在IVIG治疗期间和用药结束后1周内记录患者不良反应发生情况.IVIG治疗结束1个月后,采用改良mRS评分评估临床疗效,将患者按疗效分为有效组和无效组. 结果 共纳入患者26例,男性11例,女性15例,年龄16～ 57岁,平均(25±10)岁.患者发病至开始IVIG治疗的时间为8～68 d(中位数26 d).治疗1个月后,有效14例(显效6例、好转8例),有效率为53.8％.IVIG治疗至临床症状改善的患者时间为7 ～30 d,平均17 d.有效组男性占比高于无效组[64.3％(9/14)比16.7％(2/12),P＜0.05].男性患者有效率高于女性患者[81.8％(9/11)比33.3％(5/15),P＜0.05].观察期内出现发热3例、肝功能异常2例、皮疹1例,经减慢IVIG输注速度并给予保肝、抗过敏治疗,患者均恢复正常. 结论 IVIG治疗抗NMDA受体脑炎有效且相对安全,可作为一线治疗方案.

abstractsObjective To evaluate the efficacy and safety of intravenous immunoglobulin (IVIG) for treatment of anti-N-methyl-D-aspartatc (NMDA) receptor encephalitis.Methods Data of patients with anti-NMDA receptor encephalitis seen in Xuanwu Hospital, Capital Medical University from January 2012 to December 2014 were collected and a retrospective study was conducted.All patients received the first course of treatment with IVIG 0.4 g/(kg · d) , once daily for 5 consecutive days.The adverse reactions of IVIG during the observational period of IVIG administration and one week thereafter were recorded.The therapeutic effect of IVIG was assessed by using modified Rankin Scale one month post IVIG.According to the therapeutic effect of IVIG, patients were divided into effective group and ineffective group.Results Twenty-six patients were enrolled, including 11 male and 15 female with an average age of (25 ± 10) years (16 to 57 years).The duration from symptom onset to starting treatment of IVIG was 8-68 days (median 26 days).Treatment effects were assessed after one month post IVIG.Fourteen patients (53.8％) had improvement (effective group, including 6 patients who were improved significantly and 8 patients improved).The mean duration between the treatment of IVIG and clinical improvements was 17 (range 7-30) days.Percentage of male in the effective group was higher than that in the ineffective group [64.3％ (9/14) vs.16.7％ (2/12), P ＜ 0.05].The efficacy rate in males patients was higher than that in female patients[81.8％ (9/11) vs.33.3％ (5/15), P ＜0.05].During the observational period, 3 patients had fever, 2 patients had abnormality of liver function, and 1 patient had rash.The symptoms and abnormality of laboratory tests disappeared after reducing the speed of IVIG infusion, liver-protective and antianaphylactic treatment.Conclusion The treatment with IVIG for anti-NMDA receptor encephalitis was effective and relatively safe, therefore IVIG could be used as the first-line immunotherapy.