目的 观察谷氨酰胺对急性重症胰腺炎患者的应用效果.方法 选取2019年7月至2021年5月郑州大学第一附属医院收治的86例急性重症胰腺炎患者,按照随机数表法分为两组,观察组43例接受常规治疗及谷氨酰胺治疗,参照组43例接受常规治疗.检测患者的炎症反应相关指标[白介素-6(IL-6)、白细胞-17(IL-17)、肿瘤坏死因子-α(TNF-α)、白介素-10(IL-10)]、肠道黏膜功能相关指标[脂肪酶(LPS)、血清肠脂肪酸结合蛋白(IFABP)、淀粉酶(AMY)、D-乳酸(D-Lac)、二胺氧化酶(DAO)]及免疫功能相关指标(免疫球蛋白),评价患者的临床疗效.结果 观察组患者治疗后血清IL-17、TNF-α、IL-6水平低于参照组(P＜0.05),研究组IL-10水平高于参照组(P＜0.05);观察组患者治疗后LPS、IFABP、AMY、D-Lac、DAO水平低于参照组(P＜0.05);观察组患者治疗后机体免疫球蛋白水平高于参照组(P＜0.05);观察组临床总有效率(93.02％)高于参照组(74.42％)(P＜0.05).结论 谷氨酰胺治疗可以调节急性重症胰腺炎患者体内的炎症因子水平,从而抑制炎症反应的发生;同时可以上调患者体内的免疫球蛋白水平,增强机体免疫功能;还能改善患者的肠道黏膜屏障功能,使临床疗效得以提升.

Objective:To investigate the clinical features of patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis misdiagnosed as mental disorder, improve the early diagnosis rate and reduce misdiagnosis.Methods:The clinical data of patients with anti-NMDA receptor encephalitis diagnosed at the First Affiliated Hospital of Zhengzhou University from 2012 to 2018 were collected. Patients misdiagnosed as mental disorders were screened out. Their psychiatric symptom characteristics, disease course characteristics, imaging and laboratory findings, treatment and prognosis were retrospectively analyzed.Results:A total of 121 cases of anti-NMDA receptor encephalitis were collected, and 43 cases of mental disorders were screened out. Sixteen of the 43 patients (37.2%) had prodromal symptoms, and all the patients had psychiatric behavioral abnormalities (100%), including 32 cases (74.4%) of seizures, 13 cases (30.2%) of decreased level of consciousness, 21 cases (48.8%) of involuntary movements, 15 cases (34.9%) of decreased memory, 8 cases (18.6%) of speech dysfunction, and 8 cases (18.6%) of other neurological symptoms (central hyperventilation, autonomic dysfunction). Memory loss was observed in 15 cases (34.9%), speech dysfunction in 8 cases (18.6%), other neurological symptoms (central hypoventilation, autonomic dysfunction) in 8 cases (18.6%), and various symptoms may appear simultaneously or successively in the same patient. Thirty-eight cases had complete resolution of symptoms or only minor physical impairment, and 5 cases had recurrent admissions with mental abnormalities and seizures. The recurrence rate accounted for 11.6% (5/43).Conclusions:The clinical manifestations of anti-NMDA receptor encephalitis are complex and varied. Most of them have mental behavior abnormalities as the first symptom, which is easily misdiagnosed as mental disorder and delayed treatment will lead to prolonged disease course and poor prognosis.