Department of Neuroscience, Monash University, Melbourne, Australia.
Department of Neuroscience, Monash University, Melbourne, Australia; Department of Neuroscience, Monash Health, Melbourne, Australia; Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia.
J Autoimmun. 2019 Jan;96:24-34. doi: 10.1016/j.jaut.2018.10.014. Epub 2018 Oct 26.
To perform a systematic review of the current scientific literature in order to identify variables associated with patient prognosis in autoimmune encephalitis.
We performed a systematic literature search using MEDLINE, Embase, PubMed and PsychInfo databases. We selected studies that explored the correlation between early clinical and paraclinical findings, and patient outcomes. Data was extracted, analyzed and recorded in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
Forty four publications detailing 2823 subjects matched our inclusion criteria. There was considerable heterogeneity in methodology, patient profile, investigation results and clinical outcome measures. Findings were often discrepant for cases of anti-NMDAR encephalitis when compared with other causes of autoimmune encephalitis. Delay in immunotherapy contributed to a variety of worse outcomes for patients with different subsets of autoimmune encephalitis. Altered consciousness, ICU admission and no use of immunotherapy were variables associated with poor prognosis in anti-NMDAR encephalitis. Older age, sex, the presence of status epilepticus, CSF abnormalities and MRI changes were unlikely to have significant prognostic value. The influence of antibody titers, autonomic dysfunction and underlying malignancy was unclear.
A number of variables were identified to have potential predictive value for outcomes in autoimmune encephalitis. Heterogeneous study design, size and quality were major limiting factors in this review.
对当前关于自身免疫性脑炎患者预后相关因素的科学文献进行系统回顾。
我们使用 MEDLINE、Embase、PubMed 和 PsychInfo 数据库进行了系统文献检索。我们选择了探讨早期临床和辅助检查结果与患者结局之间相关性的研究。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，我们对数据进行了提取、分析和记录。
有 44 篇详细描述了 2823 名受试者的文献符合我们的纳入标准。研究方法、患者特征、检查结果和临床结局指标存在很大的异质性。与其他自身免疫性脑炎相比，抗 NMDAR 脑炎的研究结果往往存在差异。免疫治疗的延迟导致不同自身免疫性脑炎亚组的患者出现各种不良结局。意识改变、入住 ICU 和未使用免疫治疗是抗 NMDAR 脑炎预后不良的相关因素。年龄较大、性别、癫痫持续状态、CSF 异常和 MRI 改变不太可能具有显著的预后价值。抗体滴度、自主神经功能障碍和潜在恶性肿瘤的影响尚不清楚。
确定了一些变量，这些变量对自身免疫性脑炎的结局具有潜在的预测价值。研究设计、规模和质量的异质性是本综述的主要限制因素。
