抗N-甲基-D-天冬氨酸受体脑炎合并纵隔畸胎瘤1例报告及文献复习

doi:10.20047/j.issn1673-7210.2023.18.38

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摘要抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎是一种复杂的自身免疫性神经精神综合征，既往文献报道了抗NMDAR脑炎与女性卵巢畸胎瘤相关，但抗NMDAR脑炎联合纵隔畸胎瘤较为罕见，临床特点不明确，治疗存在一定局限性。本文介绍了1例抗NMDAR脑炎合并纵隔畸胎瘤14岁男性患者，病程中持续存在四肢抽搐及口周不自主运动，先后予以激素冲击治疗、血浆置换、丙球蛋白、利妥昔单抗及多种抗癫痫药物合并使用，效果不佳，切除纵隔畸胎瘤，病情好转后出院。本文结合病历及文献资料综述了抗NMDAR脑炎合并畸胎瘤的发病机制、临床表现及治疗等，以期提高临床医师对该疾病的认知度。

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	汤瑶1　　王欢1　　黄凤琴1　　罗兴梅2

关键词 ：自身免疫性脑炎, 抗N-甲基-D-天冬氨酸受体, 纵隔畸胎瘤, 超难治性癫痫持续状态

Abstract：Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a complex autoimmune neuropsychiatric syndrome. Previous literature has reported that anti-NMDAR encephalitis is associated with female ovarian teratoma, however, anti-NMDAR encephalitis combined with mediastinal teratoma is rare. The clinical characteristics are not clear, and the treatment has certain limitations. This article present a 14-year-old male patient with anti-NMDAR encephalitis and mediastinal teratoma. During the course of the disease, there were persistent convulsions of the limbs and involuntary movements around the mouth. Hormone shock therapy, plasma exchange, proglobulin, rituximab, and a variety of antiepileptic drugs were used in combination, poor effect. Resection of mediastinal teratoma, condition improved after discharge. In this paper, the pathogenesis, clinical manifestations, and treatment of anti-NMDAR encephalitis complicated with teratoma were reviewed based on medical records and literature, in order to improve clinicians’ awareness of this disease.

Key words： Autoimmune encephalitis Anti-N-methyl-D-aspartate receptor Mediastinal teratoma Ultra-refractory status epilepticus

基金资助:贵州省卫生健康委员会科学技术基金项目（gzwjkj2020-1-019）。

通讯作者: 罗兴梅（1974.2-），女，硕士，主任医师，硕士生导师；研究方向：神经疾病。

作者简介: 汤瑶（1994.3-），女，贵州医科大学临床医学院2020级老年医学专业在读硕士研究生；研究方向：神经疾病。

引用本文:

汤瑶1　　王欢1　　黄凤琴1　　罗兴梅2. 抗N-甲基-D-天冬氨酸受体脑炎合并纵隔畸胎瘤1例报告及文献复习[J]. 中国医药导报, 2023, 20(18): 169-173.
TANG Yao1 WANG Huan1 HUANG Fengqin1 LUO Xingmei2. Anti-N-methyl-D-aspartate receptor encephalitis combined with mediastinal teratoma: a case report and literature review. 中国医药导报, 2023, 20(18): 169-173.

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