抗N-甲基-D天冬氨酸受体脑炎运动障碍临床分析

The analysis of characteristics of movement disorders in anti-N-methyl-D-aspartate receptor encephalitis

目的比较成人抗N-甲基-D天冬氨酸受体(N-methyl-D-aspartate receptor encephalitis,NMDAR)脑炎中运动障碍与非运动障碍患者临床特征的差异。方法回顾性分析2014年7月至2020年12月南京脑科医院神经内科连续性收治的确诊为抗NMDAR脑炎的患者,并分为运动障碍组和非运动障碍组,比较两组间临床变量的差异。结果共纳入125例患者,运动障碍组71例,非运动障碍组54例。与非运动障碍组相比,运动障碍组的发病年龄较小[(26.0(19.0,32.0)岁vs.30.5(21.0,47.0)岁,P=0.016]、住院天数较长[(31.0(23.0,42.0)d vs.22.5(15.0,28.0)d,P=0.008]、mRS较高[急性期:4.0(3.0,5.0)vs.3.0(2.0,4.0),P<0.001;出院:2.0(1.0,4.0)vs.1.0(0.0,2.0),P=0.007]以及女性(67.6%vs.42.6%,P=0.005)、发热(74.6%vs.38.9%,P<0.001)、癫痫(76.1%vs.59.3%,P=0.045)及通气不足(21.1%vs.5.6%,P=0.014)较多见。结论发病年龄较小、女性、住院时间长、急性期和出院高mRS、发热、癫痫及通气不足的患者,更多出现运动障碍,应进行早期识别与干预。

Objective electroencephalogram and imaging findings between adults with and without movement disorders in anti-NMDAR encephalitis.Methods between July 2014 and December 2020 were retrospectively analyzed and divided into two groups(movement disorders group and non-movement disorders group).Clinical factors were compared between patients with and without movement disorders using independent t test,Mann-Whitney test,χ2test,correction for continuityχ2test or Fisher’s exact test.ResultsA total of 125 patients were enrolled,including 71 in the movement disorder group and 54 in the non-movement disorder group.Compared with the non-movement disorders group,the movement disorders group had lower age[26.0(19.0,32.0)years vs.30.5(21.0,47.0)years,P=0.016],longer hospital stay[31.0(23.0,42.0)vs.22.5(15.0,28.0),P=0.008],and higher mRS[acute stage:4.0(3.0,5.0)vs.3.0(2.0,4.0),P<0.001;discharge:2.0(1.0,4.0)vs.1.0(0.0,2.0),P=0.007],and the more prevalence of female(67.6%vs.42.6%,P=0.005),fever(74.6%vs.38.9%,P<0.001),epilepsy(76.1%vs.59.3%,P=0.045)and central hypoventilation(21.1%vs.5.6%,P=0.014).Conclusion age,female,longer hospital stay,high mRS at acute stage and discharge,fever,epilepsy and central hypoventilation are more likely to have movement disorders,which needs early identification and intervention.