Yu Yachun, Wu Yu, Cao Xiaoli, Li Jing, Liao Xiangling, Wei Junxiang, Huang Wen
Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, P. R. China, 530021.
Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, P. R. China, 530021.
Mult Scler Relat Disord. 2021 Jan;47:102604. doi: 10.1016/j.msard.2020.102604. Epub 2020 Oct 27.
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune nervous system disease that has become increasingly recognized. This retrospective study is aimed to analyze the relations between clinical manifestations and blood brain barrier (BBB) integrity in anti-NMDAR encephalitis patients.
Anti-NMDAR encephalitis patients were admitted to the First Affiliated Hospital of Guangxi Medical University from April 2014 to April 2020. Patients were grouped by the normal BBB and damaged BBB groups according to the cerebrospinal fluid (CSF) albumin/serum albumin (QAlb). Neutrophil-to-lymphocyte ratio (NLR) in peripheral blood was used for estimating the inflammatory status. The modified Rankin Scale (mRS) was used to assess prognosis.
Seventy-three anti-NMDAR encephalitis patients were diagnosed based on the autoimmune encephalitis diagnosis criteria of 2016. Fifty-three (72.6%) patients were in the normal BBB group and twenty (27.4%) were in the BBB damaged group. There were no significant differences in gender, age, psychiatric disturbances, epilepsy, speech disorder, motor dysfunction, memory dysfunction, and autonomic dysfunction between the two groups (p>0.05). Nevertheless, the proportions of decreased consciousness, ICU admission, NLR, CSF protein and intrathecal IgG synthesis (IgGIF, IgGLoc) in the damaged BBB group were higher than that in the normal BBB group (p<0.05). Patients (79.2%) with normal BBB had good prognosis compared to patients with damaged BBB (50%) after 2 months follow-up. The median mRS before and after immunotherapy in the damaged BBB group were significantly higher than that in the normal BBB group (p<0.01, p<0.05, respectively). Additionally, QAlb increased was positively correlated with the quantitative intrathecal IgG synthesis (IgGLoc: r=0.66; IgGIF: r=0.433, all p<0.001).
The dysfunction of BBB can be helpful in evaluating its prognosis since QAlb showed associations with ICU admission, NLR, a higher CSF protein, intrathecal IgG synthesis (IgGLoc, IgGIF) and mRS score after 2 months follow-up.
抗N-甲基-D-天冬氨酸受体（抗NMDAR）脑炎是一种日益受到认可的自身免疫性神经系统疾病。本回顾性研究旨在分析抗NMDAR脑炎患者的临床表现与血脑屏障（BBB）完整性之间的关系。
2014年4月至2020年4月期间，广西医科大学第一附属医院收治了抗NMDAR脑炎患者。根据脑脊液（CSF）白蛋白/血清白蛋白（QAlb）将患者分为血脑屏障正常组和血脑屏障受损组。采用外周血中性粒细胞与淋巴细胞比值（NLR）评估炎症状态。采用改良Rankin量表（mRS）评估预后。
根据2016年自身免疫性脑炎诊断标准，诊断出73例抗NMDAR脑炎患者。53例（72.6%）患者属于血脑屏障正常组，20例（27.4%）患者属于血脑屏障受损组。两组在性别、年龄、精神障碍、癫痫、言语障碍、运动功能障碍、记忆功能障碍和自主神经功能障碍方面无显著差异（p>0.05）。然而，血脑屏障受损组意识下降、入住重症监护病房（ICU）、NLR、脑脊液蛋白和鞘内IgG合成（IgGIF、IgGLoc）的比例高于血脑屏障正常组（p<0.05）。随访2个月后，血脑屏障正常的患者（79.2%）预后良好，而血脑屏障受损的患者（50%）预后较差。血脑屏障受损组免疫治疗前后的mRS中位数显著高于血脑屏障正常组（分别为p<0.01、p<0.05）。此外，QAlb升高与鞘内IgG合成定量呈正相关（IgGLoc：r=0.66；IgGIF：r=0.433，均p<0.001）。
血脑屏障功能障碍有助于评估其预后，因为QAlb与入住ICU、NLR、较高的脑脊液蛋白、鞘内IgG合成（IgGLoc、IgGIF）以及随访2个月后的mRS评分相关。
