抗NMDAR脑炎合并癫痫脑电图分级、抗体效价变化及临床意义

EEG Grading, Antibody Titer Changes and Clinical Significance of Anti-NMDAR Encephalitis Complicated with Epilepsy

目的 探讨抗N-甲基-D-天门冬氨酸受体(NMDAR)脑炎合并癫痫脑电图分级、抗体效价变化及临床意义。方法 选取2021年1月—2022年10月就诊15例抗NMDAR脑炎(脑炎组)及15例抗NMDAR脑炎合并癫痫(合并组)为研究对象,分析合并组临床表现。应用Nicolet EEG V32-18040180脑电图仪对患者行脑电图检查,采用ELISA法检测患者脑脊液NMDAR抗体效价,分析联合检查对抗NMDAR脑炎合并癫痫的诊断价值。据改良Rankin量表将合并组分为轻中度组、重度组,分析脑电图分级及脑脊液抗体效价对病情程度的评估价值及与病情程度的相关性。结果 合并组脑电图分级及脑脊液抗体效价增高情况均高于脑炎组(P<0.05)。脑电图分级及脑脊液抗体效价联合检查诊断抗NMDAR脑炎合并癫痫的受试者工作特征曲线下面积大于单独检查(P<0.05)。重度组脑电图分级及脑脊液抗体效价增高情况高于轻中度组(P<0.05)。抗NMDAR脑炎合并癫痫患者脑电图分级与脑脊液抗体效价呈正相关(r=0.712,P<0.05);脑电图分级、脑脊液抗体效价变化与病情严重程度均呈正相关(r=0.583、0.642,P<0.05)。脑电图分级及脑脊液抗体效价联合检查评估抗NMDAR脑炎合并癫痫病情程度的受试者工作特征曲线下面积大于单独检查(P<0.05)。结论 抗NMDAR脑炎合并癫痫患者脑电图分级及脑脊液抗体效价增高与病情严重程度相关,且联合检查对抗NMDAR脑炎合并癫痫患者具有诊断和病情程度评估价值。

Objective To investigate the EEG grading,antibody titer changes and clinical significance of anti-N-methyl-D-Aspartate receptor(NMDAR)encephalitis complicated with epilepsy.Methods From January 2021 to October 2022,15 patients with anti-NMDAR encephalitis(encephalitis group)and 15 patients with anti-NMDAR encephalitis complicated with epilepsy(combination group)were selected as the research subjects,and the clinical manifestations of the combination group were analyzed.EEG was performed by Nicolet EEG V32-18040180 electroencephalogram,and the titer of NMDAR antibody in cerebrospinal fluid(CSF)was detected by ELISA to analyze the diagnostic value of combined examination for NMDAR encephalitis complicated with epilepsy.According to the modified Rankin scale,the combination group was divided into mild to moderate group and severe group.The value of EEG grading and CSF antibody titer in evaluating the severity of the disease and its correlation with the severity of the disease were analyzed.Results The increase of EEG grading and CSF antibody titer in combination group was higher than that in encephalitis group(P<0.05).The area under the receiver operating characteristic(ROC)curve(AUC)of combined detection of EEG grading and CSF antibody titer in the diagnosis of anti-NMDAR encephalitis complicated with epilepsy was greater than that of each indicator detected alone(P<0.05).The increase of EEG grading and CSF antibody titer in severe group was more greater than that in mild to moderate group(P<0.05).There was a positive correlation between EEG grading and CSF antibody titer in patients with anti-NMDAR encephalitis complicated with epilepsy(r=0.712,P<0.05).The EEG grading and the change of CSF antibody titer were positively correlated with the severity of the disease(r=0.583,0.642,P<0.05).The AUC of combined detection of EEG grading and CSF antibody titer for assessment of the severity of anti-NMDAR encephalitis combined with epilepsy was larger than that of each indicator detected alone(P<0.05).Conclusion The increase of EEG grading and CSF antibody titer in patients with NMDAR encephalitis complicated with epilepsy is related to the severity of the disease,and the combined detection is of value in diagnosis and evaluation of the disease severity of patients with NMDAR encephalitis complicated with epilepsy.