著者
Daisuke Shigemi Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga
出版者
Society for Clinical Epidemiology
雑誌
Annals of Clinical Epidemiology (ISSN:24344338)
巻号頁・発行日
vol.1, no.1, pp.11-17, 2019 (Released:2020-06-12)
参考文献数
23

BACKGROUNDAnti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disease with multiple neurologic symptoms with or without a tumor, including ovarian teratoma. In the present study, a national inpatient database in Japan was used to investigate the characteristics, treatment, and outcomes of hospitalized patients with anti-NMDAR encephalitis who received initial treatment.METHODSUsing the Diagnosis Procedure Combination database, we identified all patients who were diagnosed with anti-NMDAR encephalitis and received initial first-line treatments (methylprednisolone, intravenous immunoglobulin, plasma exchange, and tumor removal) and second-line treatments (cyclophosphamide and rituximab) from July 2010 to March 2017. We excluded patients who received no immunotherapy or surgical treatment and those for whom data were missing. We investigated the characteristics, treatment, and outcomes of eligible patients.RESULTSIn total, 163 eligible patients were identified. Of these patients, 116 (71%) were female and 44 (28%) were ≤19 years of age. Among the female patients, 44 (38%) had a tumor. Thirty-nine patients (24%) were admitted to the intensive care unit during their hospitalization. Methylprednisolone, intravenous immunoglobulin, and plasma exchange were used as initial therapy in 82%, 56%, and 34% of patients, respectively. Second-line treatments were rarely used. Most patients were alert or had a slight disturbance of consciousness upon discharge. The proportion of patients discharged to home was 55%.CONCLUSIONSThe results of this Japanese study on anti-NMDAR encephalitis suggest that patients’ characteristics and outcomes including the male-to-female ratio, proportion of associated tumors, treatment options, and consciousness disturbance may differ from those in previous reports from other countries.

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比較的若い女性が、急に/徐々に錯乱状態や意識混濁を示した場合、脳や神経学的な病気をまず疑いますが、「抗NMDA受容体抗体脳炎」という疾患も考える必要があります。 卵巣腫瘍が発症原因の一つと考えられています。 私もDPCデータを用いて記述研究を報告しています。 https://t.co/ZFCz7iqVVk

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