自身免疫性脑炎与病毒性脑炎的临床对比研究  

Clinical comparative study of autoimmune encephalitis and viral encephalitis

作　　者：陆梦如[1] 李何鹏[1] 梁津瑜 张千[2] LU Meng-ru;LI He-peng;LIANG Jin-Yu;无(The Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China;First People′s Hospital of Nanning,Nanning 530007,China)

机构地区：[1]广西医科大学第二附属医院,广西南宁530007 [2]南宁市第一人民医院,广西南宁530007

出　　处：《吉林医学》2021年第1期16-19,共4页Jilin Medical Journal

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题[项目编号:z2015267]。

摘　　要：目的:探讨自身免疫性脑炎与病毒性脑炎的临床差异。方法:回顾性分析2017年~2019年医院收治的60例脑炎患者的临床资料,根据病因不同将入选病例分为AE组(自身免疫性脑炎)和VE组(病毒性脑炎)各30例,收集并比较两组患者的一般资料(性别、年龄、既往病史、起病形式、临床表现等)、影像学资料(头颅MRI、胸腹部CT/超声)及血清、脑脊液、脑电图等指标的差异。结果:两组患者在性别、年龄、既往病史等一般资料的比较中差异无统计学意义(P>0.05)。起病形式上AE组以亚急性起病为主,VE组以急性疾病为主,组间差异有统计学意义(P<0.05);AE和VE在首发症状中的前驱症状组间比较差异有统计学意义(P<0.05),其中AE常见癫痫发作,而VE常见前驱症状(发热、头痛、食欲减退、呕吐、腹泻、流涕、咽痛、肌肉酸痛或精神淡漠)。脑脊液检查显示AE和VE在CSF蛋白质含量异常指标差异有统计学意义(P<0.05),以VE中CSF蛋白质含量异常占比较高。AE和VE的血液学检查中,肿瘤标志物检测水平差异有统计学意义(P<0.05),以AE最为显著。两组患者头颅、胸部和腹部影像学检查中均以颅脑MRI异常占比最高,脑电图检查结果中两组患者均全部异常。多因素Logistic回归分析结果显示起病形式、前驱症状、癫痫发作、不自主运动以及脑脊液CSF蛋白质含量异常两组差异有统计学意义(P<0.05)。结论:自身免疫性脑炎与病毒性脑炎患者通常无一般资料的差异,但前者亚急性起病、好发癫痫,VE中常见CSF蛋白质含量异常,AE常合并有肿瘤标志物增高,影像学检查中患者颅脑MRI异常占比较高,而脑电图检查全部异常。Objective To explore the clinical difference between autoimmune encephalitis and viral encephalitis.Method The clinical data of 60 cases of encephalitis in our hospital from 2017 to 2019 were analyzed retrospectively,according to the different etiology,the selected cases were divided into AE group(autoimmune encephalitis)and VE group(viral encephalitis),30 cases in each group.The general data(gender,age,past medical history,onset form,clinical manifestation,etc.),imaging data(MRI of head,CT/ultrasound of chest and abdomen),serum,cerebrospinal fluid,EEG and other indexes of the two groups were collected and compared.Results There was no significant difference between the two groups in terms of gender,age and previous medical history(P>0.05).In the form of onset,AE was mainly subacute,VE was mainly acute,the difference between the groups was significant(P<0.05);AE and VE in the first symptom were significantly different between the groups(P<0.05),in which AE was common epileptic attack,while VE was common precursor symptoms(fever,headache,anorexia,vomiting,diarrhea,runny nose,sore throat,muscle ache or apathy);Cerebrospinal fluid examination showed that there was significant difference between AE and VE in the abnormal index of CSF protein content,especially in VE(P<0.05);In haematological examination of AE and VE,there was a significant statistical difference in the detection level of tumor markers,with AE being the most significant(P<0.05);In the imaging examination of the head,chest and abdomen of the two groups,the proportion of brain MRI abnormalities was the highest;in the EEG examination results,all the patients in the two groups were abnormal.The results of multivariate logistic regression analysis showed that the onset form,prodromal symptoms,seizures,involuntary movements and CSF protein content were all statistically significant(P<0.05).Conclusion There is no general data difference between the patients with autoimmune encephalitis and viral encephalitis,but the former is subacute onset and prone to epil

关 键 词：自身免疫性脑炎 病毒性脑炎 临床对比 分析研究 

分 类 号：R512.3[医药卫生—内科学] R742.9[医药卫生—临床医学]