摘要
目的了解自身免疫性脑炎(autoimmune encephalitis,AE)患者的临床特征和预后。方法采用2013–2019年四川大学华西医院病历资料,对AE患者的临床特征、实验室检查、治疗及预后进行回顾性研究。患者出院时采用改良Rankin量表(mRS)评估临床预后,预后分为良好(mRS评分0~2分)和不良(mRS评分3~6分),logistic多因素回归分析患者预后不良的危险因素。结果本研究共纳入121例患者,男女比例为1∶1.1,确诊时年龄段集中在中青年。抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患者占64.5%(78例)。有33.1%(40例)的AE患者首诊于精神科。有62.8%(76例)的患者存在前驱症状。AE患者入院时常见临床表现为认知功能障碍(104例,86.0%)、思维障碍(90例,74.4%)、行为改变(88例,72.7%)。NMDAR抗体在脑脊液中滴度高于血清中的滴度。双阳性抗体在6例患者中检出。42例患者(34.7%)的头部磁共振无异常。71例患者(58.7%)脑电图异常。111例患者(91.7%)接受了一线免疫治疗,61例患者(50.4%)出院后仍存在神经精神后遗症状。logistic多因素回归分析显示意识障碍〔比值比(OR)=4.230,95%可信区间(CI):1.540~11.617;P=0.005〕、行为改变(OR=2.997,95%CI:1.068~8.406;P=0.037)、运动障碍(OR=7.753,95%CI:1.446~41.578;P=0.017)与AE患者预后不良相关。结论AE患者突出表现为认知功能损害,一半患者存在遗留症状。脑脊液和血清抗体滴度变化无平行关系。免疫治疗方法选择对预后影响无差异。运动障碍、意识障碍、行为改变是影响AE预后的独立危险因素。
Objective To investigate the clinical features and prognosis of autoimmune encephalitis(AE).Methods Accessing data from the electronic medical records of patients receiving care at West China Hospital,Sichuan University,China between 2013 and 2019,we conducted a retrospective study of the disease characteristics,laboratory examinations,treatment,and prognosis of AE patients.Before they were discharged,modified Rankin Scale(mRS)was used to assess the prognosis of AE patients and their mRS scores were then used to categorize patients as having good prognosis(mRS scores of 0-2)or poor prognosis(mRS scores of 3-6).Multivariate logistic regression was used to analyze risk factors associated with poor prognosis.Results A total of 121 patients were included in the study.The male-tofemale ratio was 1∶1.1.At the time of diagnosis,patients were mainly from the age group of young to middle-aged individuals.Among the 121 patients,64.5%(78 patients)had anti-N-methyl D-aspartate receptor(NMDAR)encephalitis,accounting for the largest proportion.33.1%(40 patients)first visited the Department of Psychiatry for medical assistance.62.8%(76 patients)showed prodromal symptoms.The common clinical manifestations of the AE patients at the time of admission included cognitive dysfunction(104 patients,86.0%),thought disorder(90 patients,74.4%),and altered behaviors(88 patients,72.7%).The NMDAR antibody titers were higher in the cerebrospinal fluid(CSF)than those in the serum.Double-positive antibodies were detected in 6 patients.No abnormality was observed in the brain magnetic resonance imaging(MRI)of 42 patients(34.7%).Electroencephalography abnormalities were observed in 71 patients(58.7%).111 patients(91.7%)received first-line immunotherapy and 61 patients(50.4%)still had neuropsychiatric deficits when they were discharged.Multivariate logistic regression revealed that consciousness disorder(odds ratio[OR]=4.230,95%confidence interval[CI]:1.540-11.617;P=0.005),altered behavior(OR=2.997,95%CI:1.068-8.406;P=0.037)and movement disorder
作者
杨润楠
葛汾汾
蒋静文
王越
张伟
YANG Run-nan;GE Fen-fen;JIANG Jing-wen;WANG Yue;ZHANG Wei(Mental Health Center,West China Hospital,Sichuan University,Chengdu 610041,China;Biomedical Big Data Center,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2022年第1期142-148,共7页
Journal of Sichuan University(Medical Sciences)
关键词
自身免疫性脑炎
临床特征
预后
Autoimmune encephalitis
Clinical feature
Prognosis
