Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Guang Zhou Road 264, Nanjing, 210029, Jiangsu, China.
Department of Video-Electroencephalogram, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China.
Sci Rep. 2020 Jul 1;10(1):10753. doi: 10.1038/s41598-020-67485-6.
The clinical manifestations of patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis in East China and factors associated with prognosis were analyzed. A retrospective study of 106 patients (58 females; 48 males) with anti-NMDAR encephalitis in East China was carried out from June 2015 to February 2019. Clinical features and factors influencing outcomes were reviewed. Behavioral changes were observed in 74.5% (79/106) of patients, and comprised the initial symptoms in 61.3% (65/106). Seizures were observed in 67% (71/106) of patients, and served as initial symptoms in 31.1% (33/106). A total of 54.9% (39/71) of seizures were focal seizures. More clinical symptoms were observed in female patients than in male patients (P = 0.000). Similarly, background activity (BA) with high cerebrospinal fluid (CSF) antibody titers at the peak stage was more severe in female patients than in male patients (P = 0.000). The Binary logistic regression and receiver operating characteristic (ROC) curve analyses revealed the factors associated with poor outcomes included consciousness disturbance (OR 4.907, 95% CI 1.653-14.562, P = 0.004; area: 65.4%, sensitivity: 44.2%, specificity: 86.5%, P = 0.014), EEG BA (OR 3.743, 95% CI 1.766-7.932, P = 0.001; area: 76.6%, sensitivity: 73%, specificity: 75%, P = 0.000), number of symptoms (OR 2.911, 95% CI 1.811-4.679, P = 0.000; area: 77.1%, sensitivity: 59.5%, specificity: 78.6%, P = 0.000) and CSF antibody titer (OR 31.778, 95% CI 8.891-113.57, P = 0.000; area: 83.9%, sensitivity: 89.2%, specificity: 78.6%, P = 0.000). EEG BA and number of symptoms were associated with CSF antibody titers. Consciousness disturbances, EEG BA, number of symptoms and CSF antibody titers served as predictors of poor outcomes.
对华东地区抗 N-甲基-D-天冬氨酸受体（抗-NMDAR）脑炎患者的临床表现及与预后相关的因素进行分析。对 2015 年 6 月至 2019 年 2 月期间华东地区 106 例抗-NMDAR 脑炎患者（58 例女性；48 例男性）进行回顾性研究。回顾临床特征及影响预后的因素。结果 74.5%（79/106）的患者表现为行为异常，其中 61.3%（65/106）为首发症状。67%（71/106）的患者出现癫痫发作，其中 31.1%（33/106）为首发症状。54.9%（39/71）的癫痫发作为局灶性发作。女性患者的临床症状较男性患者多（P = 0.000）。同样，在高峰阶段，女性患者的脑脊液（CSF）抗体滴度较高的背景活动（BA）较男性患者更严重（P = 0.000）。二元逻辑回归和受试者工作特征（ROC）曲线分析显示，意识障碍（OR 4.907，95%CI 1.653-14.562，P = 0.004；面积：65.4%，灵敏度：44.2%，特异性：86.5%，P = 0.014）、EEG BA（OR 3.743，95%CI 1.766-7.932，P = 0.001；面积：76.6%，灵敏度：73%，特异性：75%，P = 0.000）、症状数（OR 2.911，95%CI 1.811-4.679，P = 0.000；面积：77.1%，灵敏度：59.5%，特异性：78.6%，P = 0.000）和 CSF 抗体滴度（OR 31.778，95%CI 8.891-113.57，P = 0.000；面积：83.9%，灵敏度：89.2%，特异性：78.6%，P = 0.000）与不良预后相关。EEG BA 和症状数与 CSF 抗体滴度有关。意识障碍、EEG BA、症状数和 CSF 抗体滴度是不良预后的预测因素。
