抗N-甲基-D-天冬氨酸受体脑炎预后不良和复发的危险因素分析  

Analysis of the risk factors for poor prognosis and recurrence in patients with anti-NMDAR encephalitis

作　　者：吴茜[1] 汪晓楠[1] 杨庆林[1] 刘磊[1] 彭玉晶 乔志新[1] 王佳伟[1] Wu Qian;Wang Xiaonan;Yang Qinglin;Liu Lei;Peng Yujing;Qiao Zhixin;Wang Jiawei(Department of Neurology,Beijing Tong Ren 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

出　　处：《中华预防医学杂志》2023年第2期247-252,共6页Chinese Journal of Preventive Medicine

基　　金：北京市自然科学基金(7192040);国家自然科学基金(81771313);首都医科大学基金(PVZ21093)。

摘　　要：为探讨抗N-甲基-D-天冬氨酸受体(anti-N-methyl-D-aspartate receptor,anti-NMDAR)脑炎预后不良和复发的危险因素。采用单中心、观察性队列研究,回顾性分析2014年1月至2020年10月期间在我院神经内科住院的抗NMDAR脑炎患者44例。结果显示,单因素分析表明,预后不良组发病到免疫治疗间隔时间显著长于预后良好组(t=2.045,P=0.047),预后不良组的病程显著长于预后良好组(t=4.127,P=0.000 2),临床表现有运动障碍的患者预后不良显著增多(Fisher精确检验:P=0.014),预后不良组脑MRI异常者显著多于预后良好组(Fisher精确检验:P=0.017),预后不良组脑电图慢波>50%者显著多于慢波<50%者(Fisher精确检验:P<0.001)。首次发病免疫治疗时间<3个月、病程长、颅内压高、脑脊液蛋白高的患者易复发。二分类logistic 回归分析表明,患者有运动障碍、脑MRI异常、脑电图慢波大于50%是预后不良的危险因素(OR值分别为4.687、4.978和24.500,P值分别为0.018、0.016和0.000)。首次发病一线免疫治疗时间<3个月为复发的危险因素(OR值17.231,P=0.010)。综上,运动障碍、脑MRI异常和脑电图慢波大于50%可能是患者预后不良的危险因素,首次发病时免疫治疗时间短于3个月,可能是复发的危险因素。To investigate the risk factors of poor prognosis and recurrence in patients with anti-NMDAR encephalitis.A single center,observational cohort study was used to retrospectively analyze 44 patients with anti NMDAR encephalitis hospitalized in the Department of Neurology of Beijing Tong Ren Hospital from January 2014 to October 2020.The results showed that the interval from onset to immunotherapy in the poor prognosis group was significantly longer than that in the good prognosis group(t=2.045,P=0.047),and the course of disease in the poor prognosis group was significantly longer than that in the good prognosis group(t=4.127,P=0.0002).The number of patients with clinical manifestations of dyskinesia was significantly increased(Fisher exact test:P=0.014).The patients with abnormal brain MRI in the poor prognosis group were significantly more than those in the good prognosis group(Fisher exact test:P=0.017),and the patients with slow wave>50%in the poor prognosis group were significantly more than those with slow wave<50%(Fisher exact test:P<0.001).Patients with the first onset of immunotherapy time<3 months,long course of disease,high intracranial pressure,and high cerebrospinal fluid protein are prone to relapse.Bivariate logistic regression analysis showed that patients with dyskinesia,abnormal brain MRI,and slow wave EEG more than 50%were risk factors for poor prognosis(OR values were 4.687,4.978,and 24.500,respectively;P values were 0.018,0.016,and 0.000,respectively).The time of first-line immunotherapy for the first onset<3 months was the risk factor for recurrence(OR 17.231,P=0.010).In conclusion,dyskinesia,abnormal brain MRI and slow wave of EEG more than 50%may be the risk factors for poor prognosis of patients.The duration of immunotherapy less than 3 months after the first onset might be the risk factor for recurrence.

关 键 词：抗N-甲基-D-天冬氨酸受体脑炎 复发 预后 危险因素 

分 类 号：R742.9[医药卫生—神经病学与精神病学]