抗甲状腺抗体阳性和阴性的抗N-甲基-D-天冬氨酸受体脑炎临床特点比较

Comparison of clinical characteristics of anti-N-methyl-D-aspartate receptor encephalitis with positive and negative anti-thyroid antibodies

目的比较抗甲状腺抗体(ATAbs)阳性和阴性的抗N-甲基-D-天冬氨酸(NMDA)受体脑炎临床特点的差异,明确ATAbs阳性的抗NMDA受体脑炎的临床特点及机制。方法收集郑州大学第一附属医院神经内科自2016年1月至2019年4月确诊为抗NMDA受体脑炎的53例患者临床资料,按ATAbs阳性和阴性分为2组,比较2组患者临床特征、实验室检查结果及预后情况。结果53例患者中,ATAbs阳性患者16例,女性11例(68.8%);ATAbs阴性患者37例,女性11例(29.7%);ATAbs阳性组与ATAbs阴性组间女性比例差异有统计学意义(P<0.05)。ATAbs阳性组患者意识水平下降、精神行为异常或认知障碍及癫痫的发生率高于ATAbs阴性组患者,但差异没有统计学意义(P>0.05)。2组患者前驱表现、首发症状(精神行为异常或认知障碍、癫痫)、主要临床表现、并发症发生率差异亦没有统计学意义(P>0.05)。与ATAbs阴性组相比,ATAbs阳性组病程中最大改良Rankin量表(mRS)评分更高[4(4,5)vs.3(2,5)],风湿免疫系列抗体异常率更高(50.0%vs.13.6%),采用2种及2种以上免疫治疗措施比例更高(93.7%vs.51.4%),差异均有统计学意义(P<0.05)。结论ATAbs阳性的抗NMDA受体脑炎临床表现与ATAbs阴性相似,但程度更为严重,且ATAbs阳性患者多合并有多种抗体异常,需要更积极的免疫治疗。

Objective To summarize and compare the clinical characteristics of anti N-methyl-D-aspartate(NMDA)receptor encephalitis with positive and negative anti-thyroid antibodies(ATAbs),and explore the clinical characteristics and possible mechanism of anti-NMDA receptor encephalitis with positive ATAbs.Methods The clinical data of 53 patients with definitely diagnosed anti-NMDA receptor encephalitis,admitted to our hospital from January 2016 to April 2019,were collected.The patients were divided into two groups according to positive and negative ATAbs,and the clinical characteristics,experimental results and prognoses of the two groups were compared.Results Among the 53 patients,16 were combined with positive ATAbs,of which 11 were female(68.8%);37 were combined with negative ATAbs,of which 11 were female(29.7%);number of female patients in the positive ATAbs group was significantly larger than that in the negative ATAbs group(P<0.05).The incidences of decreased consciousness,abnormal mental behavior or cognitive impairment,and epilepsy in the positive ATAbs group were higher than those in the negative ATAbs group,but the differences were not statistically significant(P>0.05).There were no significant differences in prodromal manifestations,first symptoms(abnormal mental behavior or cognitive impairment,and epilepsy),main clinical manifestations,and incidence of complications between the two groups(P>0.05).As compared with the negative ATAbs group,positive ATAbs group had significantly higher maximum modified Rankin scale scores(4[4,5]vs.3[2,5]),abnormal rate of rheumatic immunity antibodies(50.0%vs.13.6%),and rate of adopting two or more immunotherapy measures(93.7%vs.51.4%;P<0.05).Conclusion The clinical manifestations of anti-NMDA receptor encephalitis in the positive ATAbs patients are similar to those in the negative ATAbs patients,but the illness is more serious;moreover,the positive ATAbs patients are mostly combined with multiple antibody abnormalities,which may require more active immunotherapy.