MRI阳性或阴性抗NMDAR脑炎免疫治疗维持方案与患者预后的关系  

Association between maintenance regimens for immunotherapy and prognosis in patients with MRI-positive or MRI-negative anti-N-methyl-D-aspartate receptor encephalitis

作　　者：王柯黙 严翠华 姜荆 刘学伍 WANG Kemo;YAN Cuihua;JIANG Jing;LIU Xuewu(Carotid and Cerebrovascular Ultrasound,Department of Neurosurgery,The First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院神经外科-颈脑血管超声,江苏苏州215006 [2]山东大学齐鲁医院神经内科 [3]山东第一医科大学附属山东省立医院神经内科

出　　处：《精准医学杂志》2024年第6期486-490,共5页Journal of Precision Medicine

基　　金：国家自然科学基金项目(26010105131843)。

摘　　要：目的分析不同颅脑磁共振(MRI)表现的抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的免疫治疗维持方案与患者预后的关系。方法收集2016年1月—2021年1月于齐鲁医院确诊的抗NMDAR脑炎94例患者的诊治和随访资料,比较本病相关MRI结果阳性组(M组,35例)和阴性组(N组,59例)患者发病特点,以及免疫治疗的维持方案与患者远期预后的关系。结果经过为期4~73个月的随访,M组患者中位fCASE为1(0,3)分,24例出现症状学预后不良;N组患者中位fCASE为0(0,1)分,21例出现症状学预后不良;N组患者的预后好于M组(P<0.05)。M组中,行长期(疗程≥6个月)免疫治疗的患者症状学预后更好(P<0.05);N组患者短期(疗程<6个月)与长期免疫治疗效果无显著差异(P>0.05)。结论颅脑MRI发现相关责任病灶的自身免疫性脑炎患者预后相对较差,应采用更长期的免疫治疗维持方案。Objective To investigate the association between the maintenance regimens for immunotherapy and prognosis in patients with anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis and different cranial MRI manifestations.[WTHX]Me-thods Diagnosis,treatment,and follow-up data were collected from 94 patients with a confirmed diagnosis of anti-NMDAR encephalitis in Qilu Hospital from January 2016 to January 2021,and the features of the disease were compared between the positive MRI group(group M with 35 patients)and the negative MRI group(group N with 59 patients),as well as the association between the maintenance regimens for immunotherapy and the long-term prognosis of patients.[WTHX]Results After follow-up for 4-73 months,group M had a median fCASE score of 1(0,3),with 24 patients exhibiting poor symptomatic prognosis,and group N had a median fCASE score of 0(0,1),with 21 patients exhibiting poor symptomatic prognosis,suggesting that group N had a better prognosis than group M(P<0.05).In group M,the patients who received long-term(treatment duration≥6 months)immunotherapy had abetter symptomatic prognosis(P<0.05),while in group N,there was no significant difference in treatment outcome between the patients receiving short-term(treatment duration<6 months)immunotherapy and those receivinglong-term immunotherapy(P>0.05).[WTHX]Conclusion Autoimmune encephalitis patients with related responsible lesions found by cranial MRI have a relatively poor prognosis and should receive a longerterm of maintenance regimen for immunotherapy.

关 键 词：抗N-甲基-D-门冬氨酸受体脑炎 磁共振成像 免疫疗法 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R745[医药卫生—临床医学]