抗NMDAR脑炎的脑脊液Aβ和tau蛋白生物标志物与疾病严重程度及预后的关系

β-amyloid and tau cerebrospinal fluid biomarkers in anti-NMDAR encephalitis about disease severity and prognosis

目的探究脑脊液Aβ和tau在抗NMDAR脑炎患者中的临床价值。方法以2019-07—2022-06郑州大学第一附属医院神经内科收治的34例抗NMDAR脑炎患者和13例非炎症性神经疾病患者为研究对象,收集临床资料和随访资料进行回顾性研究。结果抗NMDAR脑炎组患者较对照组出现明显的发热、意识障碍、癫痫、认知障碍、精神行为异常(P<0.05);脑脊液Aβ_(1-42)、Aβ_(1-40)明显低于对照组(P<0.001)。抗NMDAR脑炎患者脑脊液Aβ_(1-42)与MoCA评分(r=0.433,P=0.031)相关。多因素回归分析表明抗NMDAR脑炎患者脑脊液Aβ_(1-42)对疾病严重程度(OR=0.979,95%CI:0.962~0.997,P=0.023)、3个月疾病预后情况(OR=0.992,95%CI:0.986~0.999,P=0.020)有影响。结论抗NMDAR脑炎患者脑脊液Aβ水平明显降低,且与认知水平相关,可能是抗NMDAR脑炎患者疾病严重程度和预后情况的独立危险因素。

Objective To explore the clinical value of Aβand tau in the cerebrospinal fluid of patients with anti-NMDAR encephalitis.Methods Thirty-four patients with anti-NMDAR encephalitis and 13 patients with non-inflammatory neurological diseases who hospitalized at the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from July 2019 to June 2022 were included for a retrospective study.Results Compared with the control group,the anti-NMDAR group showed obvious fever,consciousness disturbance,epilepsy,cognitive impairment,mental behavior abnormalities(all P<0.05),and lower Aβ_(1-42),Aβ_(1-40) in cerebrospinal fluid.Aβ_(1-42) in cerebrospinal fluid was correlated with MoCA score(r=0.433,P=0.031)in patients with anti-NMDAR en⁃cephalitis.Multivariate Logistic regression analysis showed that Aβ_(1-42) in cerebrospinal fluid can affect the disease severity(OR=0.979,95%CI:0.962-0.997,P=0.023)and prognosis at 3 months(OR=0.992,95%CI:0.986-0.999,P=0.020)of anti-NMDAR encephalitis.Conclusion The level of Aβin cerebrospinal fluid was significantly de⁃creased in patients with anti-NMDAR encephalitis and correlated with cognitive level,which may be an indepen⁃dent risk factor for disease severity group and prognosis in patients with anti-NMDAR encephalitis.