泰国农村儿童抗n -甲基- d -天冬氨酸(NMDA)受体脑炎的预后

IF 0.3 Q4 PEDIATRICS
V. E. Saengow, Kasama Bhudhisawasdi
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引用次数: 0

摘要

抗n -甲基-d-天冬氨酸受体(NMDAR)脑炎疗效良好;然而,在发展中国家,关于小儿抗nmdar脑炎结果的报道很少。我们的目的是报道泰国农村地区儿童抗nmdar脑炎的临床结果。这项回顾性队列研究招募了2015年5月1日至2020年3月31日在Maharat Nakhon Ratchasima医院住院的年龄在1个月至15岁之间,诊断为抗nmdar脑炎的儿童。记录基线特征和调查。一线治疗是单独静脉注射甲基强的松龙、脉冲注射甲基强的松龙加静脉注射免疫球蛋白(IVIG)或单独使用IVIG。二线治疗是每月静脉注射环磷酰胺或硫唑嘌呤。采用改良Rankin量表(MRS)于一线治疗后1、3、6、12、18和24个月进行评估,以确定临床结果。评估可能影响结果的因素。共纳入17例患者,平均年龄8岁,女性占76.46%。82.35%的患者发生癫痫发作,52.94%转为癫痫持续状态。70.59%的患者接受一线治疗,采用脉冲甲泼尼龙加IVIG。82.35%的患者在12个月时获得完整随访。根据MRS评分,首次诊断时94.12%报告重度残疾,治疗1个月后47.06%改善为中度至轻度残疾,6个月和12个月时完全康复的分别为40%和78.57%。不同类型的一线和二线治疗对临床结果没有影响。抗nmdar脑炎预后很好;及时诊断是必要的。癫痫持续状态等合并症可能影响临床结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcome of Pediatric Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis in Rural Area of Thailand
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis has a very good outcome; however, there are few reports in developing countries regarding the outcome of pediatric anti-NMDAR encephalitis. We aimed to report the clinical outcome of pediatric anti-NMDAR encephalitis in the rural area of Thailand. This retrospective cohort study recruited children between the age of 1 month and 15 years with the diagnosis of anti-NMDAR encephalitis admitted at Maharat Nakhon Ratchasima Hospital from 1st May 2015 to 31th March 2020. Baseline characteristics and investigation were recorded. The first-line treatment was intravenous pulse methylprednisolone alone, pulse methylprednisolone plus intravenous immune globulin (IVIG), or IVIG alone. The second-line treatment was monthly intravenous cyclophosphamide or azathioprine. The modified Rankin Scale (MRS) was used for evaluation at 1, 3, 6, 12, 18, and 24 months after receiving first-line treatment to determine clinical outcomes. The factors that may affect the outcomes were evaluated. In total, 17 patients were recruited, with the mean age of 8 years, and 76.46% were female. 82.35% of patients developed seizures, and 52.94% turned to status epilepticus. 70.59% received first-line treatment as pulse methylprednisolone plus IVIG. 82.35% received complete follow-up at 12 months. According to MRS score, at first diagnosis 94.12% reported severe disability, at 1 month after receiving treatment, 47.06% improved to moderate–mild disability, and at 6 and 12 months, 40% and 78.57% had complete recovery, respectively. Different types of first-line and second-line treatments did not affect the clinical outcome. Comorbidity of status epilepticus affected MRS. Anti-NMDAR encephalitis has a very good prognosis; prompt diagnosis is necessary. Comorbidity as status epilepticus may affect the clinical outcome.
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