单病程及复发性抗富亮氨酸胶质瘤失活1蛋白脑炎临床及预后分析

Clinical features and outcomes in relapsing and monophasic patients with anti-leucine-rich glioma-inactivated 1 encephalitis

目的比较抗富亮氨酸胶质瘤失活1蛋白(LGI1)脑炎复发组与单病程组临床特征、检查、诊断治疗及预后差异。方法收集郑州大学第一附属医院2015年1月至2019年1月确诊抗LGI1脑炎并给予免疫治疗患者,分为复发组与单病程组。回顾性分析患者临床资料、治疗方法、治疗时间及预后。结果33例抗LGI1脑炎患者中,复发组12例,单病程组21例,两组随访时间差异无统计学意义(P>0.05)。两组患者在性别、年龄、起病诱因、重症监护、临床表现、急性期改良Rankin量表(mRS)评分差异无统计学意义(均P>0.05)。两组患者血、脑脊液(CSF)检测阳性率、低钠血症、心电图、脑电图、CSF、磁共振异常率及病灶累及部位方面差异无统计学意义(均P>0.05)。复发组及单病程组患者确诊时间差异无统计学意义(P>0.05)。复发组患者中位免疫治疗时间为102.5 d,单病程组为194.0 d,两组相比差异有统计学意义(P=0.001)。单病程组患者最后随访预后差0例(mRS>2分);复发组患者预后差6例,其中死亡4例。与单病程组患者相比,复发组患者预后差(P=0.007)。结论复发在抗LGI1脑炎中很常见。复发组患者较单病程组接受免疫治疗时间短,预后差。

Objective To analyze the differences of clinical characteristics and outcomes between relapsing and monophasic patients with anti-leucine-rich glioma-inactivated 1(anti-LGI1)encephalitis.Methods Medical records of confirmed anti-LGI1 encephalitic patients who underwent immunotherapy were retrospectively collected from January 2015 to January 2019 in the first affiliated hospital of Zhengzhou University.Clinical data,treatment methods,duration of treatment and outcomes were analyzed between the relapsing and monophasic groups.Results Among the 33 anti-LGI1 encephalitic patients,there were 12 and 21 cases in the relapsing and monophasic groups,respectively.No difference was found in age,sex,precipitating factors,intensive care unit(ICU)admission,symptoms and modified Rankin Scale(mRS)score in the acute phase(P>0.05).As to the lab test and image examination,no statistic difference was found in serum and cerebral spinal fluid(CSF)positive rate,hyponatremia,abnormal rate of electrocardiogram(ECG),electroencephalogram(EEG),CSF and magnetic resonance imaging(MRI)and lesion locations(P>0.05).No difference was found in time to diagnose the disease between the 2 groups(P>0.05).The median immunotherapy period was 102.5 days in relapsing group and 194.0 days in monophasic group,with a statistic difference(P=0.001).No patients had bad outcomes in the monophasic group at the last follow-up,while 6 patients had poor outcomes in the relapsing group(4 patients died).The patients in relapsing group had a worse prognosis compared to those in the monophasic group(P=0.007).Conclusions Relapse is common in anti-LGI1 encephalitis.Patients in the relapsing group received a shorter term of immunotherapy and had worse outcomes than those in the monophasic group.