抗N-甲基-D-天冬氨酸受体脑炎临床分析及血清抗体动态观察

Clinical analysis and serum antibody titres follow-up of anti-N-methyl-D-aspartate receptor encephalitis

目的研究抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的临床特点及其血清抗NMDAR抗体动态变化情况。方法分析2013年1月至2017年3月期间我院收治的54例抗NMDAR脑炎患者的临床表现〔以改良Rankin量表(mRS)评估病情严重程度〕、脑脊液及血清的抗NMDAR抗体滴度,头颅影像学特点,治疗方案及复发情况。并于患者出院后随访观察血清抗NMDAR抗体滴度变化情况,随访时间为出院半年、1年、2年,如复发则立即检测抗体滴度,随访截至2017年12月底。结果本组抗NMDAR脑炎患者女性平均发病年龄低于男性〔(21.5±17.4)岁比(34.6±18.4)岁,P=0.01〕,且疾病严重程度女性重于男性〔中位mRS评分分别为女性4(1,5)分,男性2.5(1,5)分,P=0.002)〕。患者疾病严重程度与血清及脑脊液中抗体滴度呈显著正相关(血清:r=0.458,P=0.004;脑脊液:r=0.387,P=0.020)。抗NMDAR脑炎复发患者12例(22.2%),复发症状大多轻于首次发病〔mRS 3.5(1,5)分比1(1,3)分,P=0.002〕。54例患者中31例患者成功进行了血清抗NMDAR抗体随访,复发组抗体滴度上升患者比例大于未复发组(66.67%比10.53%,P=0.002)。结论本组抗NMDAR脑炎患者女性与男性比较,发病年龄偏低,疾病严重程度偏重;抗NMDAR脑炎存在复发表现,复发症状大多症状较轻。血清抗NMDAR抗体滴度在复发组中更容易出现上升表现。

Objective To retrospectively analyze the clinical features of anti-N-methyl-D-aspartate(anti-NMDA)receptor encephalitis and the follow-up of serum antibodies.Methods We collected the data of 54 cases with anti-NMDAR encephalitis from January 2013 to March 2017 and analyzed the data of clinical features,modified Rankin scale(mRS),cranial imaging characteristics,treatment measures,recurrence and serum and cerebrospinal fluid antibody titer follow-up.The follow-up period was up to December 2017.Results The mean age of onset of the female patients with NMDA receptor encephalitis was lower than that of the male patients(21.5±17.4 vs 34.6±18.4,P=0.01),and the disease severity of the female patients was higher than that of the male patients[median mRS score was 4(1,5)vs.2.5(1,5),P=0.002].There was a significant positive correlation between the disease severity and the antibody titer in serum and CSF(P=0.004 in serum,P=0.020 in CSF).12 patients(22.2%)had relapses of NMDA receptor encephalitis,most of the relapses were less severe than the first onset[mRS 3.5(1,5)vs 1(1,3),P=0.002].31 patients were followed up with anti NMDA receptor antibody successfully.The proportion of patients with increased antibody titer in relapse group was higher than that in the non-relapse group(66.67%vs.10.53%,P=0.002).Conclusions Compared with males,anti-NMDAR female patients are younger and more severe.Most of the symptoms of anti-NMDAR encephalitis relapse are mild.Serum antibody titre in the relapse group is more likely to rise.