抗NMDA受体脑炎患者临床特征及预后影响因素的研究  

Clinical features and prognostic factors in patients with anti-NMDAR encephalitis in East China

作　　者：苗爱亮 余传勇[1,2] 郁媛文 王小姗[1,2] 葛剑青[1,2] MIAO Ailiang;YU Chuanyong;YU Yuanwen;WANG Xiaoshan;GE Jianqing(Department of Neurology,Nanjing Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China;Video-Electroencephalogram,Nanjing Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院神经内科,江苏南京210029 [2]南京医科大学附属脑科医院视频脑电图室,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2021年第8期1185-1189,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金青年项目(81501126);江苏省青年医学重点人才(QNRC2016053);南京脑科医院青年人才项目。

摘　　要：目的:分析华东地区抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎患者的临床表现及影响预后的因素。方法:对2015年6月—2020年2月南京脑科医院就诊的106例抗NMDAR脑炎患者(男48例,女58例)临床特点及影响预后的因素进行回顾性研究。结果:74.5%(79/106)的抗NMDAR脑炎患者出现行为异常,61.3%(65/106)患者起始症状为行为异常。67.0%(71/106)患者出现癫痫发作,31.1%(33/106)患者首发症状为癫痫发作。54.9%(39/71)癫痫发作为局灶性发作。脑脊液(cerebrospinal fluid,CSF)抗体滴度高的患者出现临床症状的数量多于CSF抗体滴度低的患者。分析92例患者的114次脑电图(electroencephalography,EEG),发现在起病12 d时EEG背景活动明显加重。72.5%(74/102)患者磁共振正常,27.45%(28/102)患者出现脑损伤。在疾病高峰期,23例患者接受动脉自旋标记(arterial spin labeling,ASL)。其中9例大脑结构异常的患者ASL显示高灌注。13例大脑结构正常的患者ASL也显示局灶性高灌注。二元Logistic回归分析显示,抗NMDAR脑炎患者预后不良相关的因素包括意识障碍,EEG背景活动,临床症状数量和CSF抗体滴度增高。结论:抗NMDAR脑炎患者临床症状数与CSF抗体滴度有关。意识障碍、EEG背景活动恶化、临床症状数量和CSF抗体滴度增加是预后不佳的预测因素。Objective:The clinical manifestations of patients with anti-N-methyl-D-aspartate receptor(anti-NMDAR)encephalitis in East China and factors associated with prognosis were analyzed. Methods:A retrospective study of 106 patients(58 females,48 males)with anti-NMDAR encephalitis in East China was carried out from June 2015 to February 2020. Clinical features and factors influencing outcomes were reviewed. Results:Behavioral changes were observed in 74.5%(79/106)of patients,and comprised the initial symptoms in 61.3%(65/106). Seizures were observed in 67%(71/106)of patients,and served as initial symptoms in 31.1%(33/106). A total of 54.9%(39/71)of seizures were focal seizures. The patients with high cerebrospinal fluid(CSF)antibody titers experienced more clinical symptoms than those with low CSF antibody titers. One hundred and fourteen electroencephalography(EEG)or video EEG recordings were obtained from 92 patients. EEG background activity(BA)was significantly aggravated at 12 days. A total of 72.5%(74/102)of patients showed normal magnetic resonance imagings(MRIs). Brain lesions were observed in 27.45% of patients(28/102). During the peak stage of the disease,focal high blood flow with normal MRIs were observed from 56.52%(13/23)arterial spin labeling(ASL)of anti-NMDAR encephalitis patients. Focal high blood flow with brain lesions were observed in 39.13%(9/23)ASL of patients. The binary logistic regression analyses revealed the factors associated with poor outcomes included consciousness disturbance,EEG BA,number of symptoms and CSF antibody titer. Conclusion:EEG BA and number of symptoms are associated with CSF antibody titers. Consciousness disturbances,EEG BA,number of symptoms and increasing CSF antibody titers served as predictors of poor outcomes.

关 键 词：抗N-甲基-D-天冬氨酸受体脑炎 临床症状 脑脊液抗体滴度 脑电图 预后 

分 类 号：R512.3[医药卫生—内科学]