自身免疫性脑炎抗体检测在不明原因成人首发癫痫患者诊断及治疗中的临床价值

Clinical value of autoimmune encephalitis antibody detection in the diagnosis and treatment of adult patients with new-onset unexplained epilepsy

目的:探讨自身免疫性脑炎(AE)抗体检测在不明原因成人首发癫痫患者诊断及治疗中的临床价值,为癫痫的病因诊断及伴发癫痫的自身免疫性脑炎的诊断提供新的思路。方法:回顾性分析2015年10月至2022年4月就诊于邢台市人民医院的100例成人首发癫痫患者,所有患者均行血液及脑脊液自身免疫性脑炎抗体检测。整理抗体阳性患者年龄、性别、临床特征、脑脊液、影像学及脑电图等资料,并进行6个月以上的随访观察。记录随访期间的癫痫控制率及人均再住院次数。结果:100例患者中,23例患者抗体阳性(23.0%),其中13例为男性,中位发病年龄为34岁。抗体阳性患者中早期诊断组15例,73.3%的患者达到基本控制,6.7%的患者无效。延迟诊断组8例,12.5%的患者达到基本控制,62.5%的患者无效。两组癫痫控制情况及人均再住院次数比较差异均具有统计学意义(P<0.05)。结论:对于不明原因成人首发癫痫患者,尤其是伴有精神异常、认知障碍等症状的患者需及时考虑到AE的可能,并完善相关抗体检测,尽早做出诊断,早期启动免疫治疗。

Objective:To explore the clinical value of autoimmune encephalitis(AE)antibody detection in the diagnosis and treatment of adult patients with new-onset unexplained epilepsy,so as to provide a new idea for the diagnosis of the etiology of epilepsy and understanding of autoimmune encephalitis with epilepsy.Methods:A total of 100 adult patients with new-onset epilepsy admitted to Xingtai People's Hospital from October 2015 to April 2022 were retrospectively analyzed.All patients were tested for AE antibodies in blood and cerebrospinal fluid.The data of age,gender,clinical characteristics,cerebrospinal fluid,imaging and electroencephalogram were collected and the patients were followed up for more than 6 months.The epilepsy control rate and the number of rehospitalizations of the patients during the follow-up period were recorded.Results:Among the 100 patients,23 cases(23.0%)were positive for antibody,13 of them were male,and the median age of onset was 34 years old.Among the antibody positive patients,there were 15 cases in the early diagnosis group,73.3%of them achieved basic control,and 6.7%of them were ineffective.In the delayed diagnosis group,there were 8 cases,12.5%of them achieved basic control,and 62.5%of them were ineffective.There were statistically significant differences in epilepsy control rate and per capita number of rehospitalization between the two groups(P<0.05).Conclusions:The possibility of AE should be considered in time for adult patients with unexplained new-onset epilepsy,especially those with psychiatric disorders,cognitive disorders and other symptoms,and the relevant antibody detection should be implemented to make early diagnosis and start immunotherapy.