老年人抗γ氨基丁酸B型受体脑炎的临床特点

目的探讨老年人抗γ氨基丁酸B型(GABA-B)受体脑炎的临床特点。方法回顾性分析10例老年抗GABA-B受体脑炎患者临床资料,采用改良的Rankin量表(mRS)评分进行预后评估。结果10例患者主要临床表现包括痫性发作(100%)、精神行为异常(100%),认知障碍(100%),意识障碍(80%)。头颅MRI异常7例,以累及颞叶、海马、岛叶、杏仁体及扣带回等边缘系统,其中3例同时累及非边缘系统(包括额叶、放射冠)。胸部CT示肺部占位性病变3例。10例均给予免疫调节治疗。出院6个月后电话随访,死亡2例,预后不良4例,预后良好4例。结论老年抗GABA-B受体脑炎患者以痫性发作、精神行为异常、认知障碍为主要表现;头颅MRI以边缘系统异常信号多见;易合并有肿瘤,需注意肿瘤筛查及定期跟踪随访;免疫调节及抗肿瘤为主要治疗方法,预后较差。

Clinical characteristics of anti-gamma aminobutyric acid B receptor encephalitis in the elderly

Objective To study the clinical characteristics of anti-GABA-B receptor encephalitis in the elderly.Methods The clinical data of 10 elderly anti-GABA-B receptor encephalitis patients were retrospectively analyzed.The outcome of the 10 elderly anti-GABA-B receptor encephalitis patients was assessed according to their mRS score.Results The elderly anti-GABA-B receptor encephalitis patients were mainly manifested as epilepsy,mental and behavioral disorders,cognitive impairment,disorder of consciousness.Of the 7 elderly anti-GABA-B receptor encephalitis patients with abnormal brain MRI involving temporal lobe,hippocampus,insula,amygdala,cingulate gyrus and other limbic systems,3 were involved with nonlimbic system(including frontal lobe and coronal radiation).Chest CT showed pulmonary space-occupying lesions in 3 elderly anti-GABA-B receptor encephalitis patients.The 10 elderly anti-GABA-B receptor encephalitis patients patients received immunomodulation therapy and were followed up by telephone after 6 months of discharge,during which 2 died,4 had a poor outcome and 4 had a good outcome.Conclusion Elderly anti-GABA-B receptor encephalitis patients are mainly manifested as epilepsy,abnormal mental behavior and cognitive impairment.Brain MRI can show the common abnormal limbic system signals.Elderly anti-GABA-B receptor encephalitis patients are easy to be comlicated with tumor,especially with small cell lung cancer.Attention should thus be paid to cancer screening and regular follow-up.Immunomodulation therapy and anti-cancer therapy are the main therapies for tumor,but their outcome is poor.