抗 NMDA 受体脑炎：男性患者治疗效果及 miRNA 生物标志物。

Anti-NMDA Receptor Encephalitis: Efficacy of Treatment for Male Patients and miRNA Biomarker.

机构信息

Institute of Statistics, National Chiao Tung University, Hsinchu 30010, Taiwan.

出版信息

Curr Med Chem. 2020;27(24):4138-4151. doi: 10.2174/0929867325666180221142623.

DOI:10.2174/0929867325666180221142623

PMID:29473497

Abstract

BACKGROUND

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an acute form of encephalitis. Treatments for the anti-NMDA receptor encephalitis usually include steroids, intravenous immunoglobulin, plasma exchange, plasmapheresis, rituximab, cyclophosphamide and tumor resection.

OBJECTIVE

We aimed to compare the efficacy of the treatments including intravenous immunoglobulin, plasma exchange, plasmapheresis, rituximab or cyclophosphamide for male anti- NMDA receptor encephalitis patients without tumor and to discuss potential biomarkers for this disease.

METHOD

The Fisher exact test and the contingency table analysis were used to analyze the treatment efficacy for 43 male and 76 female patients. In addition, a hierarchical tree method was adopted to analyze the difference in the treatment efficacy between male and female patients.

RESULTS

The p-values of testing whether the efficacy rate of plasmapheresis (or plasma exchange) for the male patient is greater than a threshold are significantly different from the pvalues for the other two treatments. In addition, the hierarchical tree method shows that the treatment strategy associating with early recovery is different for male and female patients.

CONCLUSION

The results revealed that the efficacy rate of plasmapheresis (or plasma exchange) is not inferior to that of intravenous immunoglobulin and rituximab (or cyclophosphamide) for male patients without tumor. In addition, B-cell attracting C-X-C motif chemokine 13 (CXCL13) and microRNA let-7b have the potential to be the treatment response biomarkers for anti-NMDA receptor encephalitis. They may not be useful prognostic biomarkers for this encephalitis unless they are not biomarkers for other autoimmune encephalitides.

摘要

背景

抗 N-甲基-D-天冬氨酸（NMDA）受体脑炎是一种急性脑炎。抗 NMDA 受体脑炎的治疗方法通常包括类固醇、静脉注射免疫球蛋白、血浆置换、血浆吸附、利妥昔单抗、环磷酰胺和肿瘤切除术。

目的

我们旨在比较静脉注射免疫球蛋白、血浆置换、血浆吸附、利妥昔单抗或环磷酰胺治疗无肿瘤的男性抗 NMDA 受体脑炎患者的疗效，并探讨该病的潜在生物标志物。

方法

采用 Fisher 确切检验和列联表分析对 43 例男性和 76 例女性患者的治疗效果进行分析。此外，采用分层树方法分析了男性和女性患者治疗效果的差异。

结果

检测血浆置换（或血浆吸附）对男性患者的疗效是否大于阈值的 p 值与其他两种治疗方法的 p 值显著不同。此外，分层树方法显示，与早期恢复相关的治疗策略在男性和女性患者中有所不同。

结论

结果表明，对于无肿瘤的男性患者，血浆置换（或血浆吸附）的疗效并不逊于静脉注射免疫球蛋白和利妥昔单抗（或环磷酰胺）。此外，B 细胞趋化因子 C-X-C 基序 13（CXCL13）和 microRNA let-7b 有可能成为抗 NMDA 受体脑炎的治疗反应生物标志物。除非它们不是其他自身免疫性脑炎的生物标志物，否则它们可能不是该脑炎的有用预后生物标志物。