重复应用静注人免疫球蛋白对抗NMDAR脑炎认知障碍的疗效观察

目的探讨重复应用静注人免疫球蛋白对抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者认知障碍的疗效。 方法收集北京朝阳中西医结合急诊抢救中心神经内科自2018年12月至2021年6月诊治的以认知障碍起病的抗NMDAR脑炎患者24例，采用随机数字表法分为对照组和研究组，每组12例。对照组给予注射用甲泼尼龙琥珀酸钠联合静注人免疫球蛋白基础治疗，研究组在相同基础治疗结束2周后，重复应用静注人免疫球蛋白。观察并比较2组患者治疗前后认知障碍改善情况及不良反应发生情况。 结果研究组治疗后认知功能评分明显高于对照组，差异有统计学意义（P<0.05）。2组患者治疗期间均未出现严重不良反应，且所发生不良反应经对症治疗或治疗结束后均消失。2组患者的不良反应发生率比较，差异无统计学意义（P>0.05）。 结论重复应用静注人免疫球蛋白能显著改善抗NMDAR脑炎患者的认知障碍，且相对安全。

Observation on the efficacy of repeated intravenous administration of human immunoglobulin on cognitive impairment in patients with anti-NMDAR encephalitis

ObjectiveTo explore the efficacy of repeated intravenous administration of human immunoglobulin on cognitive impairment in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. MethodsA collection of 24 patients with anti-NMDAR encephalitis with cognitive impairment who were diagnosed and treated at the Neurology Department of Beijing Chaoyang Integrative Medicine Emergency Medical Center from December 2018 to June 2021, were randomly divided into control group and study group, with 12 cases in each group. The control group received injection methylprednisolone sodium succinate combined with intravenous human immunoglobulin basic therapy, and the study group received repeated intravenous injection of human immunoglobulin 2 weeks after the end of the same basic treatment. The improvement of cognitive impairment and the occurrence of adverse reactions were observed and compared between the two groups before and after treatment. ResultsThe cognitive function score of the study group was significantly higher than that of the control group after treatment, and the difference was statistically significant (P<0.05). There were no serious adverse reactions during the treatment period in the two groups, and the adverse reactions occurred after symptomatic treatment or disappeared after treatment. There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). ConclusionRepeated application of intravenous human immunoglobulin can significantly improve cognitive impairment in patients with anti-NMDAR encephalitis, and it is relatively safe.