抗N-甲基-D-天冬氨酸受体脑炎51例的预后分析

Prognosis analysis of 51 cases with anti-N-methyl-D-aspatate receptor encephalitis

目的 分析抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎临床症状的改善、复发及神经功能恢复情况,研究影响患者预后的相关因素.方法 对2012年6月至2015年4月于首都医科大学宣武医院神经内科住院的51例抗NMDA受体脑炎患者进行随访,通过改良Ranking （mRS）评分评估患者神经功能恢复情况,并对预后进行分析.结果 51例抗NMDAR脑炎患者中,89％（45/51）的患者完全恢复或遗留轻度神经功能缺损（mRS评分≤2分）.患者主要临床症状的转归：精神行为异常的完全恢复率为78％ （35/44）;认知功能的完全恢复率为65％（21/31）;癫痫发作的完全恢复率为94％（32/34）;25％（13/51）的患者出现复发.完全恢复组（mRS评分=0分,30例）、部分恢复组（mRS评分=1或2分,15例）及预后不佳组（mRS评分≥3分,6例）患者首次发病临床资料对比,在伴有记忆力减退（分别为17、9、6例,x2=6.664,P=0.036）、不自主运动（分别为19、4、5例,x2=7.976,P=0.019）、中枢性低通气（分别为5、0、2例,x2=6.124,P=0.047）三项上差异有统计学意义.结论 多数抗NMDAR脑炎患者预后较好,部分遗留精神行为异常、认知功能减退、癫痫发作;首次发病伴有明显的记忆力减退、不自主运动、中枢性低通气可能提示预后不佳.

Objective To analyze the improvement of clinical symptoms,relapse and neurological functional recovery and the prognostic factors of anti-N-methyl-D-aspatate receptor （NMDAR） encephalitis.Methods Follow-up was conducted for 51 hospitalized patients with anti-NMDAR encephalitis at the Department of Neurology,Xuanwu Hospital,Capital Medical University from June 2012 to April 2015.The neurological functional recovery was evaluated through modified Ranking Scale （mRS）,and the prognostic factors were analyzed.Results Among the 51 patients with anti-NMDAR encephalitis,89% （45/51） were completely recovered or remained mild neurological dysfunction （mRS score ≤ 2）.The prognosis of main clinical symptoms was as follows：78% （35/44） of the mental and behavior disorders were fully recovered,94% （32/34） of the seizures were controlled and 65% （21/31） of the cognitive deficiency were completely recovered;25% （13/51） of the patients relapsed.Comparison of clinical data of initial on-set among complete recovery patients group （mRS score =0）,partial recovery patients group （mRS score =1 or 2） and poor prognosis patients group （mRS score ≥ 3） showed that initial clinical manifestation with memory deficiency （17,9,6 cases respectively;x2 =6.664,P=0.036）,involuntary movements（19,4,5 cases respectively;x2 =7.976,P =0.019） and central hypoventilation （5,0,2 cases respectively;x2 =6.124,P =0.047） had statistically significant difference.Conclusions The majority of anti-NMDAR patients have favorable prognosis,but some of the patients may remain various degrees of neurological deficiency,including mental and behavior disorders,cognitive deficiency and seizures.Initial clinical manifestation with memory deficiency,involuntary movements and central hypoventilation may indicate a poorer prognosis.