自身免疫性脑炎49例的预后分析

Prognosis analysis of 49 cases with autoimmune encephalitis

目的分析自身免疫性脑炎的症状学特征及神经功能恢复情况,探索影响患者预后的相关因素。方法回顾性研究2013年1月~2017年2月于重庆医科大学附属第一医院确诊为自身免疫性脑炎的49例患者,进行临床资料收集并随访,使用改良Ranking量表(mRS)评估患者神经功能恢复情况,将患者分为痊愈组(mRS评分0~1分,32例),部分恢复组(mRS评分2~3分,7例)及预后不佳组(mRS评分>3分,10例)。采用有序多分类逻辑回归统计学分析方法对预后进行分析。结果 79.59%的患者获得痊愈或部分恢复。精神行为异常的完全恢复率为75.61%,癫痫发作的完全恢复率为94.29%,近事记忆力障碍完全恢复率为69.57%,不自主运动的完全恢复率为87.50%,中枢神经系统局灶性损害的完全恢复率为90.63%,16.33%的患者出现复发。三组患者首次发病的病前异常免疫状态、伴有自主神经功能障碍或中枢性低通气、单独采用激素治疗者占比比较,差异均有统计学意义(P<0.05)。病前处于异常免疫状态以及首次发病伴有自主神经功能障碍或中枢性低通气症状是自身免疫性脑炎患者预后不良的独立预测因素(P<0.05)。结论多数自身免疫性脑炎患者预后较好,部分遗留精神行为异常、记忆力下降;首次发病前处于异常免疫状态,伴有明显的自主神经功能障碍或中枢性低通气可能提示预后不佳;免疫治疗可改善患者预后。

Objective To analyze the features of clinical symptoms, neurological functional recovery and the prognostic factors of autoimmune encephalitis. Methods A retrospective study of 49 patients diagnosed with autoimmune encephalitis in the First Affiliated Hospital of Chongqing Medical University from January 2013 to February 2017 was performed. Clinical data were collected and followed up. The neurological functional recovery was evaluated through modified ranking scale（m RS）. The patients were divided into the recovery group（m RS score 0-1, 32 cases）, partial recovery group（m RS score 2-3 scores, 7 cases）, and poor prognosis group（m RS score 3 scores, 10 cases）, and the prognostic factors were analyzed using statistical methods of Logistic regression analysis of ordered categorization. Results 79.59% patients were completely recovered or remained mild neurological dysfunction. 75.61% of the mental and behavior disorders were fully recovered, 94.29% of the seizures were controlled, 69.57% of the recent memory disorders were completely recovered, 87.50% of the inadvertent movement were controlled, 90.63% of the central nervous system focal damage were fully recovered and 16.33% of the patients relapsed. Comparison of clinical data of initial onset among the three groups showed that people in abnormal immune status before onset and initial clinical manifestation with autonomic dysfunction or central hypoventilation had statistically significant difference（P〈0.05）. Abnormal immune status before the disease and the first onset accompanied by autonomic nervous dysfunction or central hypoventilation are independent predictors of poor prognosis in patients with autoimmune encephalitis（P〈0.05）. Conclusion The majority of autoimmune encephalitis patients have favorable prognosis, but some of the patients may remain various degrees of neurological deficiency, including mental and behavior disorders and recent memory disorders. People in abnormal immune status before the onset and initial clinical manifestation with autonomic dysfunction or central hypoventilation may indicate a poorer prognosis. Immunotherapy can improve outcomes.