Yan Lulu, Zhang Shuang, Huang Xiaoxue, Tang Yao, Wu Jun
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Neurol. 2021 Feb 5;12:609750. doi: 10.3389/fneur.2021.609750. eCollection 2021.
Autonomic dysfunction is a common symptom of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis; however, it has been poorly researched. The purpose of this study was to compare the clinical features, tumor occurrence, intensive care unit (ICU) admission, mechanical ventilation, imaging assessment, cerebrospinal fluid examination, disease severity, and immunotherapy in patients with anti-NMDAR encephalitis with or without autonomic dysfunction. A retrospective study of anti-NMDAR encephalitis patients diagnosed between January 2016 and April 2020 was performed at the First Affiliated Hospital of Zhengzhou University. Patients were divided into two groups according to whether they had autonomic dysfunction, and their clinical features, treatment, and prognosis were compared. A total of 119 patients with anti-NMDAR encephalitis were included in this study. Seventy-three patients (61.3%) had autonomic dysfunction, while the remaining 46 (38.7%) did not. Sinus tachycardia (69.9%) was the autonomic dysfunction with the highest incidence, while the incidences of symptoms including constipation, central hypopnea, and others gradually decreased. Compared to the group without autonomic dysfunction, the prevalence of the main clinical symptoms such as epileptic seizure ( = 0.003), involuntary movement ( = 0.028), and decreased consciousness ( < 0.001) were higher in the group with autonomic dysfunction, which also more frequently presented with complications such as pulmonary infection ( < 0.001) and abnormal liver function ( = 0.001). Moreover, the rates of ICU admission ( < 0.001) and mechanical ventilation ( = 0.001), as well as the modified Rankin scale (mRS) scores at admission ( < 0.001), maximum mRS scores during the course of disease ( < 0.001), and mRS scores at discharge ( < 0.001) were higher in the patients with autonomic dysfunction than in those without. The number of patients in the autonomic dysfunction group who underwent ≥2 immunotherapies was also higher than that in the group without autonomic dysfunction ( < 0.001). Sinus tachycardia is the most common type of autonomic dysfunction in anti-NMDAR encephalitis. Compared to patients without autonomic dysfunction, those with autonomic dysfunction had a higher incidence of epilepsy, involuntary movements, decreased consciousness, pulmonary infections, abnormal liver function, ICU admissions, and mechanical ventilation; moreover, the severity of the disease was greater, and their prognosis worse. Therefore, such patients require intensive immunotherapy.
自主神经功能障碍是抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎的常见症状；然而，对此研究较少。本研究旨在比较有无自主神经功能障碍的抗NMDAR脑炎患者的临床特征、肿瘤发生情况、入住重症监护病房（ICU）情况、机械通气情况、影像学评估、脑脊液检查、疾病严重程度及免疫治疗情况。在郑州大学第一附属医院对2016年1月至2020年4月期间诊断为抗NMDAR脑炎的患者进行了一项回顾性研究。根据患者是否存在自主神经功能障碍将其分为两组，并比较他们的临床特征、治疗及预后。本研究共纳入119例抗NMDAR脑炎患者。73例患者（61.3%）存在自主神经功能障碍，其余46例（38.7%）无自主神经功能障碍。窦性心动过速（69.9%）是发生率最高的自主神经功能障碍类型，而便秘、中枢性呼吸浅慢等症状的发生率逐渐降低。与无自主神经功能障碍组相比，有自主神经功能障碍组癫痫发作（P = 0.003）、不自主运动（P = 0.028）及意识障碍（P < 0.001）等主要临床症状的发生率更高，且肺部感染（P < 0.001）及肝功能异常（P = 0.001）等并发症也更常见。此外，有自主神经功能障碍患者的ICU入住率（P < 0.001）、机械通气率（P = 0.001）以及入院时改良Rankin量表（mRS）评分（P < 0.001）、病程中最高mRS评分（P < 0.001）和出院时mRS评分（P < 0.001）均高于无自主神经功能障碍患者。自主神经功能障碍组接受≥2次免疫治疗的患者数量也高于无自主神经功能障碍组（P < 0.001）。窦性心动过速是抗NMDAR脑炎中最常见的自主神经功能障碍类型。与无自主神经功能障碍患者相比，有自主神经功能障碍患者癫痫、不自主运动、意识障碍、肺部感染、肝功能异常、入住ICU及机械通气的发生率更高；此外，疾病严重程度更大，预后更差。因此，这类患者需要强化免疫治疗。
