Departments of Neurology.
Laboratory Medicine and Pathology.
Ann Neurol. 2018 Jan;83(1):166-177. doi: 10.1002/ana.25131.
To evaluate the incidence and prevalence of autoimmune encephalitis and compare it to that of infectious encephalitis.
We performed a population-based comparative study of the incidence and prevalence of autoimmune and infectious encephalitis in Olmsted County, Minnesota. Autoimmune encephalitis diagnosis and subgroups were defined by 2016 diagnostic criteria, and infectious encephalitis diagnosis required a confirmed infectious pathogen. Age- and sex-adjusted prevalence and incidence rates were calculated. Patients with encephalitis of uncertain etiology were excluded.
The prevalence of autoimmune encephalitis on January 1, 2014 of 13.7/100,000 was not significantly different from that of all infectious encephalitides (11.6/100,000; p = 0.63) or the viral subcategory (8.3/100,000; p = 0.17). The incidence rates (1995-2015) of autoimmune and infectious encephalitis were 0.8/100,000 and 1.0/100,000 person-years, respectively (p = 0.58). The number of relapses or recurrent hospitalizations was higher for autoimmune than infectious encephalitis (p = 0.03). The incidence of autoimmune encephalitis increased over time from 0.4/100,000 person-years (1995-2005) to 1.2/100,000 person-years (2006-2015; p = 0.02), attributable to increased detection of autoantibody-positive cases. The incidence (2.8 vs 0.7/100,000 person-years, p = 0.01) and prevalence (38.3 vs 13.7/100,000, p = 0.04) of autoimmune encephalitis was higher among African Americans than Caucasians. The prevalence of specific neural autoantibodies was as follows: myelin oligodendrocyte glycoprotein, 1.9/100,000; glutamic acid decarboxylase 65, 1.9/100,000; unclassified neural autoantibody, 1.4/100,000; leucine-rich glioma-inactivated protein 1, 0.7/100,000; collapsin response-mediator protein 5, 0.7/100,000; N-methyl-D-aspartate receptor, 0.6/100,000; antineuronal nuclear antibody type 2, 0.6/100,000; and glial fibrillary acidic protein α, 0.6/100,000.
This study shows that the prevalence and incidence of autoimmune encephalitis are comparable to infectious encephalitis, and its detection is increasing over time. Ann Neurol 2018;83:166-177.
评估自身免疫性脑炎的发病率和患病率,并与感染性脑炎进行比较。
我们对明尼苏达州奥姆斯特德县的自身免疫性和感染性脑炎的发病率和患病率进行了基于人群的比较研究。自身免疫性脑炎的诊断和亚组通过 2016 年的诊断标准定义,感染性脑炎的诊断需要确认感染病原体。计算了年龄和性别调整后的患病率和发病率。排除病因不明的脑炎患者。
2014 年 1 月 1 日自身免疫性脑炎的患病率为 13.7/10 万,与所有感染性脑炎(11.6/10 万;p=0.63)或病毒亚组(8.3/10 万;p=0.17)无显著差异。自身免疫性和感染性脑炎的发病率(1995-2015 年)分别为 0.8/10 万和 1.0/10 万患者年(p=0.58)。自身免疫性脑炎的复发或再住院次数高于感染性脑炎(p=0.03)。自身免疫性脑炎的发病率随着时间的推移而增加,从 0.4/10 万患者年(1995-2005 年)增加到 1.2/10 万患者年(2006-2015 年;p=0.02),这归因于抗体阳性病例的检出增加。非裔美国人的自身免疫性脑炎发病率(2.8 比 0.7/10 万患者年,p=0.01)和患病率(38.3 比 13.7/10 万,p=0.04)均高于白人。特定神经自身抗体的患病率如下:髓鞘少突胶质细胞糖蛋白,1.9/10 万;谷氨酸脱羧酶 65,1.9/10 万;未分类神经自身抗体,1.4/10 万;富亮氨酸胶质瘤失活蛋白 1,0.7/10 万; collapsin 反应介质蛋白 5,0.7/10 万;N-甲基-D-天冬氨酸受体,0.6/10 万;神经元核抗体 2 型,0.6/10 万;和神经胶质纤维酸性蛋白α,0.6/10 万。
本研究表明,自身免疫性脑炎的患病率和发病率与感染性脑炎相当,且其检出率随时间推移而增加。