NMDAR抗体水平对两种脑炎鉴别诊断和病情评估的作用

Role of NMDAR antibody level in differential diagnosis and assessment of disease condition for two kinds of encephalitis

目的探讨N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)抗体水平在抗NMDAR脑炎和病毒性脑炎的鉴别诊断及病情评估中的作用。方法选择2014年3月至2016年3月住院治疗的抗NMDAR脑炎患者53例为研究组,同期病毒性脑炎患者22例作为对照组。对两组患者的临床资料及血清、脑脊液的NMDAR抗体水平进行分析。结果抗NMDAR脑炎相比病毒性脑炎患者临床表现发生率存在统计学差异:有前驱感染史(χ~2=11.54,P=0.00)、发热(χ~2=16.31,P=0.00)、意识障碍(χ~2=9.02,P=0.00)、癫痫发作(χ~2=19.67,P=0.00)、不自主运动(χ~2=6.82,P=0.00)。抗NMDAR脑炎组(t=11.39,P=0.00)和病毒性脑炎组(t=10.91,P=0.00)NMDAR抗体在脑脊液中含量均显著高于血清中含量;且抗NMDAR脑炎组NMDAR抗体在血清(t=7.95,P=0.00)、脑脊液(t=16.46,P=0.00)中含量均高于病毒性脑炎组;抗NMDAR脑炎重症和普通型患者NMDAR抗体高水平者发生率在血清(χ~2=22.80,P=0.00)、脑脊液(χ~2=27.75,P=0.00)中均高于普通型患者。结论抗NMDAR脑炎和病毒性脑炎患者在临床表现上存在一定差别,血清、脑脊液中NMDAR抗体水平可作为鉴别诊断、病情评估的主要指标。

Objective To investigate the role of N-methyl-D-aspartate receptor （NMDAR） antibody level in differential diagnosis and disease condition evaluation for anti-NMDAR encephalitis and viral encephalitis. Methods Fifty-three pa- tients with anti-NMDAR encephalitis hospitalized between March 2014 and March 2016 were selected as the study group, and 22 patients with viral encephalitis in the same period were selected as control group. Clinical data and NMDAR anti- body levels in serum and cerebrospinal fluid （CSF） in two groups were analyzed. Results There were significant differ- ences in clinical manifestations including the incidences of history of prodromal infection （X^2 = 11.54, P = 0.00 ） , fever （X^2 = 16.31, P = O. 00） , disturbance of consciousness （X^2 = 9.02, P = O. 00） , epileptic seizure （X^2 = 19.67, P = 0. 00 ） and involuntary movement （X^2 = 6.82, P = 0.00 ）in two groups. The content of NMDAR antibody in CSF was significantly higher than that in serum in anti-NMDAR encephalitis group（t = 11.39,P = 0. 00） and viral encephalitis group （t = 10.91, P = 0. 00）. The contents of NMDAR antibody in C SF （t = 16.46, P = O. O0 ） and serum （ t = 7.95, P = 0.00 ） in anti-NMDAR encephalitis group were significantly higher than those in viral encephalitis group. The incidences of high-NMDAR antibody levels in serum （X^2 = 22.80 ,P = 0.00）and CSF （X^2 = 27.75, P = 0.00）in patients with severe anti-NMDAR encephalitis were significantly higher than those in patients with common anti-NMDAR encephalitis. Conclusions There are some differences in clinical manifestations between patients with anti-NMDAR encephalitis and patients with viral encephalitis. NMDAR antibody levels in serum and CSF can be served as the main indexes of differential diagnosis and disease condition evaluation.