Huang Chen-Na, Tian Xiao-Bing, Jiang Shu-Min, Chang Sheng-Hui, Wang Nan, Liu Ming-Qi, Zhang Qiu-Xia, Li Ting, Zhang Lin-Jie, Yang Li
Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China.
Neuropsychiatr Dis Treat. 2020 Nov 4;16:2649-2660. doi: 10.2147/NDT.S274487. eCollection 2020.
Infectious encephalitis (IE) and autoimmune encephalitis (AE) are symptomatically similar in clinic, however essentially different in pathogenesis. Therefore, the objective of this study was to identify specific features to distinguish the two types of encephalitis for early effective diagnosis and treatments through a comparative analysis.
Fifty-nine IE patients and 36 AE patients were enrolled. The patients with IE were divided into viral encephalitis (VE) and bacterial encephalitis (BE) according to the pathogens in cerebrospinal fluid (CSF). Patients with AE were categorized by with or without neural autoantibodies (NAAb). We further divided patients with NAAb into those with neural cell-surface antibodies (NSAbs) or intracellular antibodies (Abs). Clinical features, laboratory data, and imaging findings were compared between AE, IE, and subgroups.
Memory deficits, involuntary movement, and seizures were relatively more commonly presenting symptoms in AE patients (p < 0.05). The positive rate of Pandy test was higher in IE patients (p = 0.007). Decreased leukocyte, erythrocyte, and platelet counts in blood were found in IE patients (p < 0.05). Lower serum calcium level was found in VE compared to BE (p = 0.027). Meanwhile, higher serum calcium level was found in patients with NSAbs compared with intracellular Abs (p = 0.034). However, higher levels of LDH in CSF were found in patients with intracellular Abs (p = 0.009). In magnetic resonance imaging, hippocampus lesions were more commonly present in patients with AE (p = 0.042). Compared with AE patients, more IE patients displayed the background electroencephalogram rhythm of slow-frequency delta (p = 0.013).
Involuntary movement and memory deficits were more specifically present in AE patients. CSF Pandy, blood routine test and hippocampus lesions detections were potential markers for distinguishing AE and IE. Further, CSF LDH, and serum calcium levels were potentially useful to distinguish subgroups of encephalitis.
感染性脑炎（IE）和自身免疫性脑炎（AE）在临床上症状相似，但发病机制本质不同。因此，本研究的目的是通过对比分析确定区分这两种脑炎的特异性特征，以便进行早期有效诊断和治疗。
纳入59例IE患者和36例AE患者。IE患者根据脑脊液（CSF）中的病原体分为病毒性脑炎（VE）和细菌性脑炎（BE）。AE患者根据是否存在神经自身抗体（NAAb）进行分类。我们进一步将有NAAb的患者分为具有神经细胞表面抗体（NSAbs）或细胞内抗体（Abs）的患者。比较AE、IE及其亚组之间的临床特征、实验室数据和影像学表现。
记忆缺陷、不自主运动和癫痫发作在AE患者中相对更常见（p<0.05）。IE患者潘氏试验阳性率更高（p=0.007）。发现IE患者血液中白细胞、红细胞和血小板计数降低（p<0.05）。与BE相比，VE患者血清钙水平较低（p=0.027）。同时，与细胞内抗体患者相比，具有NSAbs的患者血清钙水平较高（p=0.034）。然而，细胞内抗体患者脑脊液中乳酸脱氢酶（LDH）水平较高（p=0.009）。在磁共振成像中，海马病变在AE患者中更常见（p=0.042）。与AE患者相比，更多IE患者脑电图显示慢频率δ波背景节律（p=0.013）。
不自主运动和记忆缺陷在AE患者中更具特异性。脑脊液潘氏试验、血常规检查和海马病变检测是区分AE和IE的潜在标志物。此外，脑脊液LDH和血清钙水平可能有助于区分脑炎亚组。
