一线免疫治疗抗N-甲基-D-天冬氨酸受体脑炎疗效及预后因素分析  

Efficacy and Prognostic Factors of First-Line Immunotherapy on Anti-N-Methyl-D-Aspatate Receptor Encephalitis

作　　者：李东景[1] 李霞[1] Li Dongjing;Li Xia(Xi'an Children's Hospital,Shaanxi Xi'an 710003,China)

机构地区：[1]西安市儿童医院

出　　处：《儿科药学杂志》2020年第1期10-14,共5页Journal of Pediatric Pharmacy

摘　　要：目的:探讨一线免疫治疗抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的疗效及预后。方法:选取2012年2月至2017年2月在西安市儿童医院住院的抗NMDAR脑炎患儿63例,采用糖皮质激素联合静脉注射免疫球蛋白进行治疗,随访患儿治疗后的改良Rankin量表(mRS)评分及复发情况,采用单因素及Logistic回归分析治疗后影响患儿mRS评分及复发的危险因素。结果:采用一线免疫治疗抗NMDAR脑炎2个月后,患儿mRS评分(1.52±0.71)分,随访1年有12.98%(8/63)患儿复发。单因素分析结果显示,mRS评分与患儿首次患病年龄、伴有不自主运动、高峰mRS评分、癫痫发作、治疗起效时间有关(P<0.05),患儿复发与患儿首次患病伴有不自主运动、高峰mRS评分、癫痫发作有关(P<0.05)。Logistic回归分析显示,mRS评分的危险因素有高峰mRS评分、伴有不自主运动、癫痫发作、治疗起效时间(P<0.05);患儿复发的危险因素有高峰mRS评分和癫痫发作(P<0.05)。结论:一线免疫治疗抗NMDAR脑炎效果明确,高峰m RS评分和癫痫发作是影响患儿治疗后短期疗效及患儿复发的重要危险因素。Objective:To probe into the efficacy and prognostic factors of first-line immunotherapy on anti-N-Methyl-D-aspatate receptor(NMDAR)encephalitis.Methods:Totally 63 children with anti-NMDAR encephalitis admitted into Xi’an Children’s Hospital from Feb.2012 to Feb.2017 were extracted as the research objects.Glucocorticoid combined with intravenous immunoglobulin injection was used for treatment,the modified Rankin Scale(mRS)score and recurrence of the patients were followed up after treatment.Univariate and Logistic regression were used to analyze the risk factors of mRS score and recurrence after treatment.Results:After treatment of two months by first-line immunotherapy,the mRS score was(1.52±0.71)points,and 12.98%(8/63)of the children relapsed after one year of follow-up.Univariate analysis showed that the mRS score was related to the age of children’s first onset,accompanied by involuntary exercise,peak mRS score,seizures and onset of treatment time(P<0.05),recurrence was associated with the first onset accompanied by involuntary movement,peak mRS score and seizures(P<0.05).Logistic regression analysis showed that the risk factors for mRS score were peak mRS score,accompanied by involuntary movement,seizures,and onset of treatment time(P<0.05),the risk factors for recurrence were peak mRS score and seizures(P<0.05).Conclusion:The first-line immunotherapy has singnificant effects of anti-NMDAR encephalitis.Peak mRS scores and seizures are important risk factors that affect the short-term efficacy and recurrence of children after treatment.

关 键 词：一线免疫治疗 抗-NMDAR脑炎 mRS评分 复发 危险因素 

分 类 号：R748[医药卫生—神经病学与精神病学]