作者：刘盼盼，何谦益，李悦，丁志方，岳悦，赵莘瑜

单位：

450000河南省郑州市，郑州大学第一附属医院神经内科

Units：

Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China

关键词：

抗N-甲基-D-门冬氨酸受体脑炎；临床特征；预后；影响因素分析

Keywords：

Anti-N-methyl-D-aspartate receptor encephalitis; Clinical characteristics; Prognosis; Root causeanalysis

CLC：

R 739.4

DOI：

10.12114/j.issn.1008-5971.2023.00.267

Funds：

河南省医学科技攻关计划联合共建项目（LHGJ20190079，LHGJ20210301）

摘要：

目的　分析ICU抗N-甲基-D天冬氨酸受体（NMDAR）脑炎患者的临床特征及其预后的影响因素。方法　回顾性选取2014年1月至2022年6月郑州大学第一附属医院收治的抗NMDAR脑炎患者218例，收集患者的临床资料。按照入院后是否入住ICU将患者分为入住ICU组（n=118）和未入住ICU组（n=100），根据出院6个月改良Rankin量表（mRS）评分将入住ICU患者分为预后良好亚组（mRS评分≤2分，n=85）和预后不良亚组（mRS评分≥3分，n=33）。ICU抗NMDAR脑炎患者预后的影响因素分析采用多因素Logistic回归分析。结果　入住ICU组入院时精神行为异常、癫痫、发热、意识障碍、中枢性低通气发生率和白细胞计数、中性粒细胞百分比、C反应蛋白、使用静脉注射用人免疫球蛋白者占比、接受血浆置换者占比及入院时、出院时、出院6个月mRS评分≥3分者占比高于未入住ICU组，嗜酸粒细胞百分比、嗜碱粒细胞百分比、单核细胞百分比、淋巴细胞百分比低于未入住ICU组，红细胞沉降率快于未入住ICU组，住院时间长于未入住ICU组（P＜0.05）。预后不良亚组发病年龄大于预后良好亚组，C反应蛋白、脑脊液蛋白质定量、脑脊液白细胞计数及出院时mRS评分≥3分者占比高于预后良好亚组（P＜0.05）。多因素Logistic回归分析结果显示，发病年龄〔OR=1.040，95%CI（1.011，1.071）〕、C反应蛋白〔OR=1.047，95%CI（1.010，1.085）〕、脑脊液白细胞计数〔OR=1.018，95%CI（1.007，1.029）〕是ICU抗NMDAR脑炎患者预后不良的独立影响因素（P＜0.05）。结论　ICU抗NMDAR脑炎患者入院时精神行为异常、癫痫、发热、意识障碍、中枢性低通气发生率较高，免疫炎症反应较重，预后较差；且发病年龄、C反应蛋白、脑脊液白细胞计数是ICU抗NMDAR脑炎患者预后不良的独立影响因素。

Abstract：

Objective To analyze the clinical characteristics of patients with anti-N-methyl-D-aspartate receptor(NMDAR) encephalitis in ICU and the influencing factors of their prognosis. Methods A total of 218 patients with anti-NMDARencephalitis admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to June 2022 were retrospectivelyselected. The clinical data of the patients were collected. According to whether the patients were admitted to ICU after admission,they were divided into ICU group (n=118) and non-ICU group (n=100) . According to the modified Rankin Scale (mRS) score at 6months after discharge, the patients in ICU were divided into good prognosis subgroup (mRS score ≤ 2, n=85) and poor prognosissubgroup (mRS score ≥ 3, n=33) . Multivariate Logistic regression analysis was used to analyze the influencing factors of prognosisof patients with anti-NMDAR encephalitis in ICU. Results The incidence of mental and behavioral abnormalities, epilepsy,fever, consciousness disorders and central hypoventilation, and white blood cell count, percentage of neutrophils, C-reactiveprotein, proportion of patients using human immunoglobulin for intravenous injection, proportion of patients undergoing plasmaexchange, and proportion of patients with mRS scores ≥ 3 at admission, discharge, and 6 months after discharge in the ICU groupwere higher than those in the non-ICU group, and the percentage of eosinophils, basophils, monocytes, and lymphocytes werelower than those in the non-ICU group, and the erythrocyte sedimentation rate was faster than that in the non-ICU group, and thehospital stay was longer than that in the non-ICU group (P < 0.05) . The age of onset in the poor prognosis subgroup was older thanthat in the good prognosis subgroup, and the the C-reactive protein, cerebrospinal fluid protein quantification, cerebrospinal fluid white blood cell count, and proportion of patients with mRS score ≥ 3 at discharge were higher than those of the good prognosissubgroup (P < 0.05) . Multivariate Logistic regression analysis results showed that age at onset [OR=1.040, 95%CI (1.011, 1.071) ] ,C reactive protein [OR=1.047, 95%CI (1.010, 1.085) ] , and cerebrospinal fluid white blood cell count [OR=1.018, 95%CI (1.007,1.029) ] were independent influencing factors of poor prognosis in patients with anti-NMDAR encephalitis in ICU (P < 0.05) .Conclusion In patients with anti-NMDAR encephalitis in ICU, the incidence of mental and behavioral abnormalities, epilepsy,fever, consciousness disturbance and central hypoventilation is higher, the immune inflammatory response is severe, and theprognosis is poor; and age of onset, C-reactive protein and cerebrospinal fluid white blood cell count are independent influencingfactors of poor prognosis in patients with anti-NMDAR encephalitis in ICU.

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