儿童与成人自身免疫性脑炎临床特征差异性的研究进展

Research Progress on Differences in Clinical Features of Autoimmune Encephalitis between Children and Adults

摘要: 自身免疫性脑炎(autoimmune encephalitis, AE)是一类由自身抗体介导的神经系统炎症性疾病，近年来其发病率呈上升趋势。大量临床研究表明，儿童与成人AE患者在病因、临床表现、治疗反应及预后方面存在显著差异。本文系统综述了儿童与成人AE的流行病学特征、病因学机制、临床表现、辅助检查、治疗策略及预后等方面的差异。儿童AE多与前驱感染相关，以抗N-甲基-D-天冬氨酸受体(NMDAR)抗体阳性为主，临床表现以精神行为异常和癫痫发作更为突出；而成人AE与肿瘤相关性更高，抗体谱系更为多样，更易出现认知功能障碍等后遗症。深入了解这些差异对于制定年龄特异性的诊疗策略、改善患者预后具有重要意义。本文还对该领域未来的研究方向进行了展望。

Abstract: Autoimmune encephalitis (AE) is a group of inflammatory disorders of the nervous system mediated by autoantibodies, whose incidence has been increasing in recent years. Substantial clinical evidence indicates significant differences between children and adult AE patients in terms of etiology, clinical manifestations, treatment response, and prognosis. This article systematically reviews the differences between pediatric and adult AE in epidemiological characteristics, etiological mechanisms, clinical presentations, auxiliary examinations, treatment strategies, and prognosis outcomes. Pediatric AE is more associated with preceding infections, predominantly characterized by anti-N-methyl-D-aspartate receptor (NMDAR) antibody positivity, and exhibits more prominent psychiatric symptoms and seizures. In contrast, adult AE shows a stronger correlation with tumors, has a more diverse antibody spectrum, and is more prone to sequelae such as cognitive impairment. Understanding these differences is crucial for developing age-specific diagnosis and treatment strategies and improving patient prognosis. This paper also provides perspectives on future research directions in this field.