摘要： 过去10余年自身免疫性脑炎经历了一场深刻的诊疗范式转变，从既往被视为罕见且难以识别的临床症候群，迅速发展成为中枢神经系统炎症性疾病的重要类别，从根本上重塑了神经科医师对急性脑炎、新发精神行为异常和快速进展性认知功能障碍的诊断思路。这一转变的核心动力在于，对特异性抗神经抗体及其相应临床症候群的持续发现与病理机制的深入理解。在诊疗水平显著提升的同时，血清抗体阴性自身免疫性脑炎诊断困境、治疗策略标准化与个体化平衡难题以及长期认知与精神症状的干预需求，成为亟待解决的关键问题。本文拟系统回顾自身免疫性脑炎诊疗范式转变的重要历程，分析当前面临的挑战，并对未来朝向精准化、全程化管理的诊疗新阶段提出展望。

关键词: 脑炎, 神经系统自身免疫疾病, 自身抗体, 精准医学, 综述

Abstract: The field of autoimmune encephalitis (AE) has undergone a profound paradigm shift in diagnosis and treatment over the past decade. Previously considered a rare and difficult-to-recognize condition, AE is now established as a major category of inflammatory central nervous system diseases. This evolution has fundamentally changed how neurologists evaluate acute encephalitis, new-onset neuropsychiatric symptoms, and rapidly progressive cognitive dysfunction. The driving force behind this shift has been the ongoing discovery of specific neural autoantibodies, together with refined characterization of their associated clinical syndromes and underlying pathology mechanisms. Despite these advances, several challenges remain. Key issues include diagnosing seronegative AE, balancing standardized and individualized treatment strategies, and managing long-term cognitive and psychiatric sequelae. This article systematically reviews the major developments underlying this paradigm shift, analyzes the core challenges currently confronting the field, and outlines future directions for achieving more precise and comprehensive patients management.

Key words: Encephalitis, Autoimmune diseases of the nervous system, Autoantibodies, Precision medicine, Review