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目的分析抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎在中国四川省的诊断现状及流行病学特征。方法运用回顾性研究的方法,收集并分析2012年1月-2017年2月四川省各级医院送检疑诊为自身免疫性脑炎患者,并送检抗NMDAR抗体的病例资料。结果①送检病例共1 714例,省会级城市医院从2012年开始送检,共送检1 511例,非省会级城市的医院2014年开始送检,共203例;送检医院逐年增多。送检科室涉及神经内科、心理科、精神科、ICU、儿科、老年病科、耳鼻喉科、感染科、急诊科、呼吸科。②送检例数逐年增多,确诊患者155例,其中女89例,男66例;年龄9~77岁,平均(27.9±12.0)岁;女性平均年龄(26.5±11.31)岁,男性平均年龄(29.0±13.0)岁。男女患者均以10~29岁年龄段构成比较高。③确诊的患者中,127例临床资料详尽,以癫痫和精神行为异常为主要症状,首诊误诊率为84.3%,18例患肿瘤(女17例,畸胎瘤占11/17)。结论四川省非省会级城市医院对自身免疫性脑炎认识程度有待提高;抗NMDAR脑炎可就诊于多个科室,早期易误诊。
Objective To analyze the diagnostic status and epidemiological characteristics of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in Sichuan Province of China. Methods A retrospective study was conducted to collect and analyze the data of patients suspected of being autoimmune encephalitis at hospitals in all levels of Sichuan Province from January 2012 to February 2017 and to submit anti-NMDAR antibodies. Results ① A total of 1 714 cases were submitted for inspection. Provincial capital city hospitals began to submit their papers for inspection in 2012 with a total of 1 511 cases. Non-capital city-level hospitals began to submit for examination in 2014 with a total of 203 cases. Inspection hospitals have been increasing year by year. The submission department involves neurology, psychology, psychiatry, ICU, pediatrics, geriatrics, otolaryngology, infectious diseases, emergency department, respiratory department. (2) The number of sentinel cases increased year by year, of which 155 cases were diagnosed, including 89 females and 66 males, ranging in age from 9 to 77 years with an average of (27.9 ± 12.0) years. The average age of females was 26.5 ± 11.31 years, 29.0 ± 13.0) years old. Male and female patients are 10 to 29 age groups constitute relatively high. ③ Among the confirmed patients, 127 cases had detailed clinical data, with epilepsy and abnormal mental behavior as the main symptoms. The first diagnosis was misdiagnosed at 84.3% and 18 with tumors (17 female and teratoma 11/17). Conclusion The awareness of autoimmune encephalitis in non-capital city-level city hospitals in Sichuan Province needs to be improved; anti-NMDAR encephalitis can be seen in many departments and early misdiagnosis.