Guo Y Y, Lü X Y, Wu Y, Chen Y, Wei Q, Zhou N, Wang K, Tian Y H
Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
Department of Neurology, the First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China.
Zhonghua Yi Xue Za Zhi. 2020 Jul 7;100(25):1942-1946. doi: 10.3760/cma.j.cn112137-20200108-00050.
To investigated cognitive and cerebral blood flow changes in a cohort of patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Fifteen patients with confirmed anti-NMDAR encephalitis from the First Affiliated Hospital of Anhui Medical University and the First Affiliated Hospital of University of Science and Technology of China between June 2015 and February 2019 were included in the study. Meanwhile, another 15 healthy subjects were selected as controls. All participants underwent neuropsychological tests for assessment of the clinical symptoms and arterial spin labeling (ASL) of magnetic resonance perfusion imaging scan were employed to evaluate cerebral perfusion. Then the relationship between changed cerebral blood perfusion and cognitive function was evaluated. Patients with anti-NMDAR encephalitis showed significantly reduced overall cognitive function (Montreal cognitive assessment (MoCA)) than healthy controls (26.5±2.5 vs 28.6±1.9, 0.015), they also exhibited poorer performance in immediate memory, recognition, attention, language and executive function than healthy controls (0.05). However, no significant differences in clinical symptoms, viability, mental state and mood were observed between the two groups (0.05). Patients with anti-NMDAR encephalitis showed significantly reduced total brain cerebral blood flow (CBF) compared with the healthy controls (0.949±0.028 vs 0.953±0.025, 0.001). Compared with the healthy controls, the patients had decreased CBF in triangular and opercular parts of bilateral inferior frontal gyrus and left central frontal gyrus, however, they showed increased CBF in the left inferior temporal gyrus and left fusiform gyrus (all 0.05). In NMDAR group, the CBF in left central anterior gyrus was negatively correlated with Stroop's Color Word-word (-0.68, 0.005). The CBF in left spindle gyrus was positively correlated with Stroop's Color Word-word (0.62, 0.015) and completion time of color trail test-A (0.81, 0.001), respectively, however, it was negatively correlated with Chinese Auditory Verbal Learning Test-immediate (-0.59, 0.020) and Verbal Fluency Test-animals (-0.58, 0.024), respectively. Patients with anti-NMDAR encephalitis have prevalent cognitive deficits such as memory, language, attention and executive dysfunction as well as changes in blood perfusion, which may be related to cognitive deficits. Changes in cerebral blood perfusion can be used as indicators for early diagnosis, disease monitoring and prognosis evaluation of anti-NMDAR encephalitis. Improving the cerebral blood flow of patients may promote the recovery of cognition.
为研究抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者队列中的认知和脑血流变化。纳入了2015年6月至2019年2月期间安徽医科大学第一附属医院和中国科学技术大学附属第一医院确诊的15例抗NMDAR脑炎患者。同时，选取另外15名健康受试者作为对照。所有参与者均接受神经心理学测试以评估临床症状，并采用磁共振灌注成像扫描的动脉自旋标记（ASL）来评估脑灌注。然后评估脑血流灌注变化与认知功能之间的关系。抗NMDAR脑炎患者的整体认知功能（蒙特利尔认知评估（MoCA））明显低于健康对照（26.5±2.5 vs 28.6±1.9，P = 0.015），他们在即时记忆、识别、注意力、语言和执行功能方面的表现也比健康对照差（P < 0.05）。然而，两组在临床症状、生存能力、精神状态和情绪方面未观察到显著差异（P > 0.05）。与健康对照相比，抗NMDAR脑炎患者的全脑脑血流量（CBF）明显降低（0.949±0.028 vs 0.953±0.025，P = 0.001）。与健康对照相比，患者双侧额下回三角部和岛盖部以及左侧额中回的CBF降低，然而，他们左侧颞下回和左侧梭状回的CBF增加（均P < 0.05）。在NMDAR组中，左侧中央前回的CBF与Stroop色词测验呈负相关（-0.68，P = 0.005）。左侧梭状回的CBF分别与Stroop色词测验（0.62，P = 0.015）和色词连线测验A的完成时间（0.81，P = 0.001）呈正相关，然而，它分别与汉语听觉词语学习测验-即时（-0.59，P = 0.020）和词语流畅性测验-动物（-0.58，P = 0.024）呈负相关。抗NMDAR脑炎患者普遍存在认知缺陷，如记忆、语言、注意力和执行功能障碍以及血流灌注变化，这可能与认知缺陷有关。脑血流灌注变化可作为抗NMDAR脑炎早期诊断、疾病监测和预后评估的指标。改善患者的脑血流量可能促进认知恢复。
