自身免疫性脑炎患者死亡的影响因素分析

Analysis of influencing factors of death in patients with autoimmune encephalitis

目的探讨自身免疫性脑炎(AE)患者死亡的影响因素。方法收集2015年8月至2021年12月于郑州大学第一附属医院确诊为AE的202例患者的临床资料,患者至少完成6个月的随访,按随访期间的生存情况将其分为死亡组(47例)和生存组(155例)。采用改良的Rankin量表(mRS)和AE临床评估量表(CASE)评估入院时疾病的严重程度,比较两组临床资料,采用logistic回归模型分析AE患者死亡的影响因素。结果两组年龄、癫痫发作、意识水平、机械通气、入住重症监护病房(ICU)、深静脉血栓、合并肿瘤、并发症个数、抗体类型、mRS评分、CASE评分、中性粒细胞/淋巴细胞比值、单核细胞/淋巴细胞比值比较,差异有统计学意义(P<0.05)。单因素logistic回归分析结果显示,年龄、癫痫发作、意识水平、机械通气、入住ICU、深静脉血栓、合并肿瘤、并发症个数、抗体类型、mRS评分、CASE评分均为AE患者死亡的影响因素(P<0.05)。多因素logistic回归分析结果显示,高龄、合并肿瘤、多个并发症、抗体类型为γ-氨基丁酸B型受体抗体、入院时CASE评分≥10分均为AE患者死亡的独立危险因素(OR>1,P<0.05)。结论AE患者预后受年龄、合并症、抗体类型等多个因素的影响,医师在临床工作中应特别关注。

Objective To investigate the influencing factors of death in patients with autoimmune encephalitis(AE).Methods Clinical data of 202 patients diagnosed with AE in the First Affiliated Hospital of Zhengzhou University from August 2015 to December 2021 were collected.The patients completed at least six months of follow-up,and were divided into death group(47 cases)and survival group(155 cases)according to their survival during follow-up.The modified Rankin scale(mRS)and clinical assessment scale for AE(CASE)were used to assess the severity of the disease at admission.The clinical data of the two groups were compared,and the influencing factors of death in AE patients were analyzed by logistic regression model.Results There were statistically significant differences in age,seizure,consciousness level,mechanical ventilation,intensive care unit(ICU)admission,deep vein thrombosis,complicated tumor,number of complications,antibody type,mRS score,CASE score,neutrophil/lymphocyte ratio,and monocyte/lymphocyte ratio between the two groups(P<0.05).Univariate logistic regression analysis showed that age,seizure,consciousness level,mechanical ventilation,ICU admission,deep vein thrombosis,complicated tumor,number of complications,antibody type,mRS score,and CASE score were all influencing factors of death in AE patients(P<0.05).Further multivariate logistic regression analysis showed that old age,complicated tumor,multiple complications,antibody typeγ-aminobutyric acid B-receptor antibody,and CASE score≥10 points on admission were all independent risk factors for death in AE patients(OR>1,P<0.05).Conclusion The prognosis of AE patients is affected by many factors such as age,comorbidities,antibody type,etc.Physicians should pay special attention to it in clinical work.