本文選題：抗N-甲基-D-天冬氨酸受體腦炎 + 環(huán)磷酰胺��； 參考：《中國(guó)當(dāng)代兒科雜志》2017年06期

【摘要】：目的分析環(huán)磷酰胺作為二線藥物治療兒童抗N-甲基-D-天冬氨酸受體(NMDAR)腦炎的療效及安全性。方法 6例激素和丙種球蛋白沖擊治療效果欠佳的抗NMDAR腦炎患者序貫給予環(huán)磷酰胺治療,進(jìn)行療效觀察及安全性隨訪。結(jié)果 6例患兒經(jīng)一線免疫治療1~4周后,在精神癥狀、癲vN發(fā)作、不自主運(yùn)動(dòng)方面癥狀減輕;3例意識(shí)水平有所改善,能進(jìn)行簡(jiǎn)單對(duì)答;所有患兒均仍有明顯的反應(yīng)遲鈍,失語、失讀、失寫、失算、失用、運(yùn)動(dòng)障礙等高級(jí)皮層功能受損癥狀。予環(huán)磷酰胺序貫治療,7 d內(nèi)6例患兒均能進(jìn)行簡(jiǎn)單對(duì)答;2~3周后3名學(xué)齡期患兒能進(jìn)行簡(jiǎn)單計(jì)算,讀寫能力有較大改善,生活自理能力基本恢復(fù);2~3個(gè)月后,6例患兒認(rèn)知功能均基本恢復(fù)至病前水平,生活能力恢復(fù)正常。無不良反應(yīng)發(fā)生及血常規(guī)、肝腎功能異常。結(jié)論兒童抗NMDAR腦炎確診后應(yīng)及早給予免疫治療,環(huán)磷酰胺序貫治療效果良好,不良反應(yīng)少,安全性高。
[Abstract]:Objective to evaluate the efficacy and safety of cyclophosphamide (cyclophosphamide) as a second line drug in the treatment of NMDAR encephalitis in children. Methods six patients with NMDAR encephalitis were treated with cyclophosphamide. Results after 1 to 4 weeks of first-line immunotherapy, the mental symptoms, seizures of epileptic vN and involuntary motor symptoms were alleviated in 3 cases. Loss of reading, dyslexia, miscalculation, apraxia, motor disorders and other advanced cortical dysfunction symptoms. Within 7 days of sequential treatment with cyclophosphamide, 3 school-age children were able to perform simple calculation after 3 weeks of simple answer, and their reading and writing abilities were improved greatly. After 2 ~ 3 months, the cognitive function of 6 children recovered to the pre-illness level, and the ability of life returned to normal. No adverse reaction and blood routine, abnormal liver and kidney function. Conclusion Children with NMDAR encephalitis should be given immunotherapy as soon as possible. Cyclophosphamide sequential therapy has good effect, less adverse reactions and high safety.
【作者單位】： 廣州醫(yī)科大學(xué)附屬第二醫(yī)院神經(jīng)內(nèi)科;
【分類號(hào)】：R742.9

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