摘要： 目的 报告4 例边缘性脑炎患者临床诊断与治疗经过，并分析其发病特点。方法与结果 对4 例临床拟诊边缘性脑炎患者的临床表现、辅助检查及治疗结果进行回顾，均以近记忆力减退伴精神症状为主诉，可合并癫痫发作（2 例），发病前无感染病史。MRI 显示边缘系统受累，T₂WI 和FLAIR成像为高信号，增强后病灶无或仅呈轻度不规则强化。临床未发现恶性肿瘤证据，经对症治疗恢复良好，远期预后较好。结论 边缘性脑炎临床表现为边缘系统受累症状与体征，影像学检查呈现海马、杏仁核、岛叶等边缘系统受累征象，增强扫描病灶无明显强化；临床无恶性肿瘤表现，经免疫治疗后患者近远期预后良好。

关键词: 脑炎, 边缘系统, 受体, N-甲基-D-天冬氨酸, 免疫抑制剂

Abstract: Objective  This article aims to present clinical manifestations and to discuss the clinical features and management of 4 patients with limbic encephalitis (LE).  Methods  The clinical presentation, MRI examination, laboratory results and treatment of 4 patients with limbic encephalitis were retrospectively analyzed, and relevant literature was reviewed.  Results  All the 4 cases presented with short-term memory deficits, psychiatric symptoms, while 2 cases were complicated with seizures. None of them had history of infection. MRI showed the involvement of limbic system, with little enhancement. T₂WI and FLAIR revealed high-intensity signal. Tumor screenings were negative, and patients improved greatly after treatment. The long-term prognosis was favorable. Conclusions  Patients with limbic encephalitis present with symptoms and signs of limbic system. Imaging examinations reveal involvement of limbic system, including hippocampus, amygdala and insular lobe, with little enhancement. Cancer screenings are negative, and immunotherapy is successful.  

Key words: Encephalitis, Limbic system, Receptors, N-methyl-D-aspartate, Immunosuppressive agents