探究抗N-甲基-D-天冬氨酸受体脑炎的复发预测指标  

The exploration for predictors of recurrent anti N-methyl-D-aspartate receptor encephalitis

作　　者：谢竹霄 马秋英[1] 刘磊[1] 李蕾[2] 王佳伟[1,3] Xie Zhuxiao;Ma Qiuying;Liu Lei;Li Lei;Wang Jiawei(Department of Neurology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Ophthalmology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Medical Research Center,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院神经内科,北京100730 [2]首都医科大学附属北京同仁医院眼科,北京100730 [3]首都医科大学附属北京同仁医院中心实验室,北京100730

出　　处：《中国医学前沿杂志（电子版）》2022年第5期27-32,共6页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：国家自然科学基金面上项目(81771313);国家自然科学基金面上项目(82171349);国家自然科学基金青年基金项目(81301029);北京市自然科学基金面上项目(7192040);北京市医院管理局“青苗”计划专项经费资助(QML20150206);北京市科技计划课题“首都特色”项目(Z171100001017039);首都医学发展重点攻关项目(2020-2-2056)。

摘　　要：目的寻找可作为抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎复发风险评估及预测的指标。方法选取2014年6月至2021年11月期间在首都医科大学附属北京同仁医院神经内科住院治疗的33例抗NMDAR脑炎患者,收集患者临床基线资料,根据患者是否复发,将患者分为复发组与未复发组,多元Logistic回归分析筛选复发相关的危险因素。结果纳入抗NMDAR脑炎患者平均年龄为(35±13)岁,男女比例13∶20。其中复发组15例,平均年龄(34±13)岁,男女比例7∶8。未复发组18例,平均年龄(35±14)岁,男女比例1∶2。通过多元Logistic回归分析显示,治疗中应用二线免疫治疗及血清神经系统副肿瘤综合征(paraneoplastic neurologic syndromes,PNS)相关抗体阳性这两项指标具有统计学差异(P<0.05),是该疾病复发的保护因素。进一步构建函数诊断模型,Y=2.3979-0.8821×血清PNS抗体-2.571×二线免疫治疗,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线),结果显示ROC曲线下面积为0.857,当诊断点选择≤-0.2484时,预测抗NMDAR脑炎不出现复发的敏感性和特异性最高,即当Y值大于-0.2484时,该疾病容易出现复发。结论应用二线免疫治疗及血清PNS抗体阳性作为临床指标可提示抗NMDAR脑炎的复发风险较低,且通过计算函数Y值可进一步评估及预测该疾病的复发风险。Objective To explore the predictors and evaluation factors for recurrent of anti N-methyl-D-aspartate receptor(NMDAR)encephalitis.Method A total of 33 in-hospital patients with anti NMDAR encephalitis in Department of Neurology of Beijing Tongren Hospital were enrolled in this study from June 2014 to November 2021.Clinical characteristics of the patients were collected.The patients were divided into relapsed group and non-relapsed group,Multivariate Logistic regression was used to analyze the risk factors for the recurrence.Result The mean age of anti NMDAR encephalitis patients was(35±13)years,with a male-to-female ratio of 13∶20.There were 15 cases in the relapsed group and the mean age was(34±13)years,with a male-to-female ratio of 7∶8.There were 18 cases in the non-relapsed group and the mean age was(35±14)years,with a male-to-female ratio of 1∶2.Multivariate Logistic regression analysis showed that using second-line immunotherapy and serum antibodies associated with paraneoplastic neurologic syndromes(PNS)were the independent protective factors for anti NMDAR encephalitis recurrence(P<0.05).Functional diagnostic model was constructed as follow:Y=2.3979-0.8821×serum PNS antibodies-2.571×second-line immunotherapy.Receiver operating characteristic(ROC)curve was plotted.The area under curve was 0.857.The sensitivity and specificity were the highest when the diagnostic point was selected≤-0.2484.Anti NMDAR encephalitis was prone to relapse when Y value>-0.2484.Conclusion Second-line immunotherapy and positive serum PNS antibodies may be the factors could indicate that the recurrent risk of anti NMDAR encephalitis was less.Risk evaluation could be calculated by functional model.

关 键 词：抗N-甲基-D-天冬氨酸受体脑炎 复发 二线免疫治疗 神经系统副肿瘤综合征 

分 类 号：R742.9[医药卫生—神经病学与精神病学]