抗N-甲基-D-天冬氨酸受体脑炎急性期严重程度及短期预后影响因素分析  

Analysis of factors influencing the severity of acute phase and short-term prognosis of anti-N-methyl-D-aspartate receptor encephalitis

作　　者：叶睿曦 蔡林君 孔雪莹 李劲梅[1] 周东[1] 洪桢[1] Rui-xi YE;Lin-jun CAI;Xue-ying KONG;Jin-mei LI;Dong ZHOU;Zhen HONG(Department of Neurology,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西医院神经内科,成都610041

出　　处：《中国现代神经疾病杂志》2024年第5期331-339,共9页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家重点研发计划项目(项目编号:2022YFC2503800);四川大学华西医院临床研究重点孵化项目(项目编号:22HXFH022)。

摘　　要：目的 探究抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患者急性期严重程度及短期预后的影响因素。方法 纳入2020年1月至2023年7月四川大学华西医院收治的60例抗NMDAR脑炎患者,根据急性期改良Rankin量表(mRS)评分分为轻症组(mRS≤3分,25例)和重症组(mRS> 3分,35例),根据我院治疗1个月后mRS评分分为短期预后良好组(mRS≤3分,32例)和短期预后不良组(mRS> 3分,28例),采用单因素和多因素Logistic回归分析筛查抗NMDAR脑炎患者急性期病情严重及短期预后不良的危险因素。结果 存在意识障碍(OR=8.975,95%CI:2.048~39.327;P=0.004)及高中性粒细胞百分比/白蛋白比值(NPAR;OR=5.004,95%CI:1.138~22.011,P=0.033)是抗NMDAR脑炎急性期病情严重的危险因素,高血清IgE水平是其急性期病情较轻的保护因素(OR=0.994,95%CI:0.989~0.999;P=0.026);女性(OR=4.380,95%CI:1.205~15.929;P=0.025)、存在意识障碍(OR=5.493,95%CI:1.535~19.657;P=0.009)及高NPAR(OR=2.949,95%CI:1.010~8.612;P=0.048)是抗NMDAR脑炎患者短期预后不良的危险因素。结论 存在意识障碍、低血清IgE水平及高NPAR是抗NMDAR脑炎患者急性期病情严重的危险因素,女性、存在意识障碍及高NPAR是其短期预后不良的危险因素。NPAR是潜在的评估抗NMDAR脑炎患者急性期严重程度及预测其短期预后的生物学指标。Objective:To explore the factors influencing the severity of acute phase and short-term prognosis of anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis,and search for potential indicators for assessing disease severity and predicting prognosis.Methods:A total of 60 patients with anti-NMDAR encephalitis admitted to West China Hospital,Sichuan University from January 2020 to July 2023 were included.According to the modified Rankin Scale(mRS)during the acute phase,they were divided into mild group(mRS≤3 score,n=25)and severe group(mRS>3 score,n=35),as well as good outcome group(mRS≤3 score,n=32)and poor outcome group(mRS>3 score,n=28)based on the mRS score after one month of treatment at our hospital.Univariate and multivariate Logistic regression analyses were used to determine the risk factors of anti-NMDAR encephalitis with severe condition during the acute phase and poor short-term prognosis.Results:Logistic regression analysis showed consciousness disorder(OR=8.975,95%CI:2.048-39.327;P=0.004)and high level of neutrophil percentage-to-albumin ratio(NPAR;OR=5.004,95%CI:1.138-22.011,P=0.033)were the risk factors of anti-NMDAR encephalitis with severe condition during the acute phase,while high level of serum IgE was the protective factor(OR=0.994,95%CI:0.989-0.999;P=0.026).Female(OR=4.380,95%CI:1.205-15.929;P=0.025),consciousness disorder(OR=5.493,95%CI:1.535-19.657;P=0.009)and high level of NPAR(OR=2.949,95%CI:1.010-8.612;P=0.048)were the risk factors of anti-NMDAR encephalitis with poor short-term prognosis.Conclusions:Consciousness disorder,low serum IgE level and high NPAR are risk factors of anti-NMDAR encephalitis with severe condition during the acute phase,while female,consciousness disorder and high NPAR are risk factors of anti-NMDAR encephalitis with poor short-term prognosis.NPAR is a potential biological indicator for assessing disease severity during the acute phase and predicting short-term prognosis of patients with anti-NMDAR encephalitis.

关 键 词：抗N-甲基-D-门冬氨酸受体脑炎 健康状况指标 预后 危险因素 LOGISTIC模型 

分 类 号：R742.9[医药卫生—神经病学与精神病学]