儿童抗N-甲基-D-天冬氨酸受体脑炎前驱事件与临床特征相关性分析

Analysis of prodromal events in pediatric patients with anti-N-methyl-D-aspartate receptor encephalitis

目的分析儿童抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎前驱事件与临床特征之间的相关性。方法回顾性分析自2014年1月至2019年3月间就诊的107例抗NMDAR脑炎的患儿前驱事件与临床特征。结果107例患儿中,52例(48.6%)患儿存在前驱事件,其中以感染性前驱事件为主(73.1%,38/52)。通过比较有无前驱事件患儿间临床特点,发现存在颅内感染前驱事件患儿比无颅内感染前驱事件患儿的发病年龄小(P=0.006),且出现肢体瘫痪(P=0.038)和睡眠障碍(P=0.037)的占比更高。另外,存在颅内感染前驱事件患儿的住院天数长于无颅内感染前驱期事件的患儿(P=0.001),且治疗前改良Rankin评分更高(P=0.008),所需的免疫球蛋白疗程次数也更多(P=0.011)。结论存在前驱事件的抗NMDAR脑炎患儿呈现出部分不同的临床特征。与无颅内感染前驱事件患儿相比,存在颅内感染前驱事件的患儿发病年龄更小,并更易出现肢体瘫痪、睡眠障碍和更高的治疗前改良Rankin评分,需要更长的住院天数和更多免疫球蛋白治疗疗程。

Objective To analyze the correlation between anti N-methyl-D-aspartate receptor(NMDAR)encephalitis prodromal events and clinical features in children.Methods A retrospective analysis was conducted on 107 pediatric patients with anti-NMDAR encephalitis from January 2014 to March 2019,to examine the correlation between prodromal events and clinical characteristics in these children.Results Of the 107 patients,52 cases(48.6%)had prodromal events,predominantly consisting of infectious prodromal events(73.1%,38 out of 52).A comparative analysis revealed that patients with a history of intracranial infection as a prodromal event were significantly younger at onset(6.0±4.7 years)compared to those without such a history(6.4±2.9 years,P=0.006).Additionally,these patients had a markedly higher incidence of limb paralysis(P=0.038)and sleep disorders(P=0.037).The hospital stay was prolonged for patients with intracranial infection prodromal events(P=0.001).Furthermore,these patients exhibited higher modified Rankin Scale(mRS)scores prior to treatment(P=0.008)and required more courses of intravenous immunoglobulin(IVIG)treatment(P=0.011).Conclusions Pediatric patients with anti-NMDAR encephalitis and prodromal events,particularly those with intracranial infections,displayed distinct clinical profiles.They were more likely to present at an earlier age with increased rates of limb paralysis and sleep disorders,necessitating longer hospital stays and additional IVIG treatments.