Anti-N-methyl-d-aspartate receptor encephalitis in Maori and Pacific Island children in New Zealand
Anti-N-methyl-d-aspartate receptor encephalitis in Maori and Pacific Island children in New Zealand
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DOI：
10.1111/dmcn.13420
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发表时间：
2017-07-01
影响因子：
3.8
通讯作者：
Sharpe, Cynthia
中科院分区：
文献类型：
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作者：
Jones, Hannah F.;Mohammad, Shekeeb S.;Sharpe, Cynthia
目的了解新西兰儿童抗N-甲基-D-天冬氨酸(抗-NMDA)受体脑炎的发病率和严重程度。方法对2008年1月至2015年10月间确诊的18岁儿童抗-NMDA受体脑炎病例进行回顾性分析。15名儿童有毛利人和/或太平洋岛屿血统。毛利族儿童的抗NMDA受体脑炎发病率为每年3.4/百万儿童(95%可信区间[CI]1.4-7.0)，太平洋地区儿童的发病率为每百万儿童每年10.0(95%可信区间4.3-19.8)，而没有毛利人或太平洋岛屿血统的儿童每年发病率为每百万儿童0.2(95%可信区间0.0-1.0)。经2年随访，67%的儿童预后良好(改良Rankin评分2分)。尽管接受一线免疫治疗的中位时间较短(13天；范围4-)，而接受二线治疗的儿童比例较高(50%)，但与其他队列相比，这一数字并不理想。解释毛利人和太平洋岛屿儿童抗NMDA受体脑炎的发生率较高，可能有更严重的表型。这些数据表明在这些人群中存在抗NMDA受体脑炎的遗传易感性。这篇论文补充说，毛利人和太平洋岛屿儿童患抗N-甲基-D-天冬氨酸(NMDA)受体脑炎的风险增加(每年每百万儿童分别为3.4和10.0)。三分之一的毛利人和太平洋岛屿儿童患有抗NMDA受体脑炎，结果很差。这篇文章由Njafang和Missa在本期的第673页上发表评论。
AimTo investigate the incidence and severity of anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis in children from New Zealand.MethodA retrospective case series was undertaken of all children (18y) diagnosed with anti-NMDA receptor encephalitis from January 2008 to October 2015.ResultsSixteen patients were identified with anti-NMDA receptor antibodies in the cerebrospinal fluid, three of whom had an associated teratoma. Fifteen children had maori and/or Pacific Island ancestry. The incidence of anti-NMDA receptor encephalitis in maori children was 3.4 per million children per year (95% confidence interval [CI] 1.4-7.0) and the incidence in Pacific children was 10.0 per million children per year (95% CI 4.3-19.8) compared with 0.2 per million children per year (95% CI 0.0-1.0) in children without maori or Pacific Island ancestry. Sixty-seven per cent of children had a good outcome (modified Rankin Score 2) at 2 years' follow-up. This compares unfavourably with other cohorts despite a shorter median time to first-line immunotherapy (13d; range 4-89) and a higher proportion of children being treated with second-line therapy (50%).Interpretationmaori and Pacific Island children have a higher incidence of anti-NMDA receptor encephalitis and possibly a more severe phenotype. These data suggest a genetic predisposition to anti-NMDA receptor encephalitis in these populations.What this paper addsmaori and Pacific Island children are at increased risk of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (3.4 and 10.0 per million children per year respectively). One third of maori and Pacific Island children with anti-NMDA receptor encephalitis have a poor outcome.This article is commented on by Njafang and Missa on page 673 of this issue.