抗NMDA受体脑炎患者临床表现、并发症及相关影响因素分析  

Clinical Manifestations and Complications in Patients with Anti-NMDA Receptor Encephalitis

作　　者：袁平乔 李佳[1] 张乐[1] 李劲梅[1] 李银萍[1] 杨蓉[1] YUAN Ping-qiao;LI Jia;ZHANG Le;LI Jin-mei;LI Yin-ping;YANG Rong(Department of Neurology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院神经内科,成都610041

出　　处：《四川大学学报（医学版）》2018年第6期979-982,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的分析抗N-甲基-D-天冬氨酸(NMDA)受体脑炎患者临床表现及并发症情况,并探讨其相关影响因素。方法回顾性收集确诊为抗NMDA受体脑炎患者的临床资料,根据患者临床症状复杂程度分为临床症状≥4种组(96例,67.1%)和<4种组(47例,32.9%),以及根据患者并发症发生情况分为有并发症组(109例)和无并发症组(34例),单因素及多因素分析其相关影响因素。结果共纳入抗NMDA受体脑炎患者143例,130例(90.9%)患者具有精神障碍,120例(83.9%)患者出现癫痫发作。并发症中,以肺部感染(84例,58.7%)和胃肠道功能紊乱(70例,49.0%)最为常见。单因素分析显示,患者临床症状复杂程度与脑电图异常、脑脊液(CSF)和血清中均出现抗NMDA受体抗体阳性有关。患者有并发症组与无并发症组在癫痫、意识障碍、入院时日常生活能力(ADL)评分和住院时间等的差异有统计学意义(P<0.05)。多因素分析显示,脑电图异常是影响患者临床症状复杂程度的预测因素[比值比(OR=2.620,P<0.05];运动障碍和患者入院时的低ADL评分是影响患者并发症的独立危险因素(OR值分别为4.338、0.980,P<0.05)。结论脑电图结果显示异常的抗NMDA受体脑炎患者临床症状复杂程度高于脑电图正常的患者;抗NMDA受体脑炎患者并发症的发生率高,运动障碍和患者入院时较差的生活自理能力是患者出现并发症的独立危险因素。Objective To investigate the clinical manifestations and complications in the patients of anti-N-methyl-D-aspartate （anti-NMDA） receptor encephalitis. Methods We retrospectively collected clinical data of 143 patients diagnosed with anti-NMDA receptor encephalitis. According to the complexity of clinical symptoms, the patients were divided into two groups： ≥4 clinical symptoms group （96 cases, 67.1%） and 〈4 group （47 cases, 32.9%）. There were 109 patients with complications and 34 patients without any complicaitons, The related factors to symptom complexity and complications were analyzed by univariate and multivariate analysis method. Results In the 143 patients of anti-NMDA receptor encephalitis, 120 （83.9%） exhibited seizures, 130 （90.9%） presented with psychiatric symptoms. Pulmonary infections （58.7%） and gastrointestinal disorders （49.0%） were the most common complications. Univariate analysis showed that the complexity of clinical symptoms was related to abnormal electroencephalography （EEG）, positive anti-NMDA receptor antibody in cerebrospinal fluid（CSF） and serum. There were more frequent seizures, disorders of consciousness, abnormal movements, central hypoventilation in the patients with complications than those in patients without complications, all the differences were signifcant （P〈0.05）. Multivariate analysis showed that abnormal EEG was an independent risk factor for symptom complexity 〔odds ratio（OR）=2.620, P〈0.05〕. The abnormal movements and the activities of daily living （ADL） on admission were predictor factors for the incidence of complications （OR=4.338, 0.980, respectively, P〈0.05）. Conclusion In the patients of anti-NMDA receptor encephalitis, abnormal EEG may related to more complex clinical symptoms. Abnormal movements and low ADL on admission seems to be independent risk factors related to the incidence of complications.

关 键 词：抗NMDA受体 脑炎 并发症 因素分析 

分 类 号：R742.9[医药卫生—神经病学与精神病学]