抗γ氨基丁酸B型受体脑炎患者远期认知功能损害的特点

Clinical characteristics of long-term cognitivedeficits in patients with anti-GABA_(B)R encephalitis

目的研究抗γ氨基丁酸B型受体(GABA BR)脑炎患者远期认知功能损害的特点。方法采用横断面研究方法,在华西医院注册登记的前瞻性数据库中筛选出42例抗GABA BR脑炎患者,进一步筛选发病2年以上且符合纳入排除标准的患者共10例。对其认知功能进行系统性评估,包括记忆功能(听觉词语学习测验、空间广度测验、视觉空间记忆测验)、执行功能(Stroop色词测验、伦敦塔测验、威斯康星分类卡片测验)、注意功能(持续操作测验)、语言功能(词语流畅性测验)、推理功能(瑞文标准推理测验)等认知领域的评估。结果10例患者中,其中男6例,女4例,年龄31~60岁,中位数41岁,随访时间24~41个月,中位数32个月。(1)记忆功能:80.0%的患者听觉延迟记忆受损,未发现听觉即刻记忆受损;40.0%的患者视空间工作记忆广度严重受损;66.7%的患者视觉空间记忆严重受损,33.3%的患者轻到中度受损。(2)执行功能:11.1%患者执行功能严重受损,11.1%患者轻到中度受损;20.0%的患者问题解决能力严重受损,20.0%的患者轻到中度受损;50.0%患者提示抽象概括能力较差,83.3%患者提示认知转移能力较差。(3)注意功能:12.5%患者持续注意能力严重受损,25.0%患者轻到中度受损。(4)语言功能:患者语义流利性无明显损害。(5)推理功能:44.4%患者推理功能严重受损,11.1%患者轻到中度受损。结论抗GABA BR自身免疫性脑炎患者在记忆、执行、注意、推理等认知功能领域存在不同程度的损害,尤其是听觉延迟记忆、视空间工作记忆广度、视觉空间记忆、抽象概括能力、认知转移能力、推理能力受损明显。

Objective To study the clinical characteristics of log-term cognitive deficits in patients with anti-gamma aminobutyric acid B receptor encephalitis.Methods Using the cross-scctional study method,42 anti-GABA_(B)R encephalitis patients were screened from medical records of West China Hospital,Sichuan University.Systematic assessment of cognitive function includes the memory function(Rcy auditory verbal learning test,Spatial span test and Brief visuospatial memory test),executive function(Stroop color-word test,London of Tower test and the Wisconsin card sorting test),attention function(Continuous performance test),language function(verbal fluency test)and reasoning function(Ravin progressive test).Results A sample of 10 anti-GABABR encephalitis patients included 6 males.The median age was 41 years(range:31-60 years),and the median follow-up time was 32 months(range:24-41 months).(1)80.0%of the patients had memory impairment of auditory delayed memory;the proportion of patients with serious impairment of spatial working memory span was 40.0%;the proportion of patients with serious impairment of visuospatial memory was 66.7%,and the proportion of patients with mild to moderate impairment was 33.3%.(2)The proportion of patients with serious impairment of executive function was 11.1%,and the proportion of patients with mild to moderate impairment was 11.1%;the proportion of patients with serious impairment of problem-solving skils was 20.0%,and the proportion of patients with mild to moderate impairment was 20.0%;the proportion of patients with impairment of abstract-generalization ability was 50.0%,and the proportion of patients with impairment of cognitive transfer capability was 83.3%.(3)The proportion of patients with serious impairment of sustained attention ability was 12.5%,and 25.0%of the patients showed mild to moderate impairment.(4)Semantic fluency of the patients showed no obvious impairment.(5)The proportion of patients with serious impairment of reasoning function was 44.4%,11.1% of the patients showed mild to moderate impairmcn.Conclusions Patients with anti-GABARR encephalitis have different degrees of cognitive impairment in different cognitive domains such as memory,executive function,attention,language function and reasoning function.Moreover,cognitive functions including auditory delayed memory,spatial working memory span,visuospatial memory,abstract-generalization ability,cognitive transfer capability and reasoning ability in these patients are significantly impaired.