From the Johns Hopkins Encephalitis Center (L.A.D.-A., J.C.P., A.V.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.K.Y., B.G., J.F.S.), Icahn School of Medicine at Mount Sinai, New York; Encephalitis Society (A.E.), Malton; and Institute of Infection and Global Health (A.E.), University of Liverpool, United Kingdom.
Neurol Neuroimmunol Neuroinflamm. 2021 Aug 13;8(6). doi: 10.1212/NXI.0000000000001064. Print 2021 Nov.
To evaluate the impact of fatigue after autoimmune encephalitis, determine associations with patients' characteristics, and identify factors that contribute to its development.
In a first cohort recruited via several encephalitis support organizations, self-reported questionnaires were used to evaluate fatigue, depression, and sleep quality in adults after autoimmune encephalitis. In a second cohort where more in-depth clinical characterization could be performed, adults with encephalitis from 2 tertiary hospitals were evaluated using the same questionnaires. Patients' characteristics were retrospectively captured.
In the first cohort (mean [SD] age; 43 [16] years, 220 [65%] female), 220 of 338 participants (65%) reported fatigue, 175 of 307 (57%) depression, and 211 of 285 (74%) poor sleep quality. In the second cohort (48 [19] years; 43 [50%] women), 42 of 69 participants (61%) reported fatigue, whereas 23 of 68 (34%) reported depression and 44 of 66 (67%) poor sleep quality, despite more than 80% having "good" modified Rankin scale (mRS) scores (0-2). Individuals with anti-NMDA receptor encephalitis reported lower fatigue scores than those with other autoimmune encephalitis types. In a multivariate analysis examining factors at discharge that might predict fatigue scores, only anti-NMDA receptor encephalitis was a (negative) predictor of fatigue and remained so when potential confounders were included.
The impact of fatigue after autoimmune encephalitis is prominent and not fully accounted for by depression or sleep quality, nor adequately captured by mRS scores for disability. Fatigue is pervasive across autoimmune encephalitis, although lower scores are reported in anti-NMDA receptor encephalitis. Fatigue should be screened routinely, considered as an outcome measure in clinical trials, and further studied from a mechanistic standpoint.
评估自身免疫性脑炎后疲劳的影响，确定与患者特征的关联，并确定导致其发生的因素。
在通过多个脑炎支持组织招募的第一队列中，使用自我报告问卷评估了自身免疫性脑炎后成年人的疲劳、抑郁和睡眠质量。在可以进行更深入临床特征描述的第二队列中，对来自 2 家三级医院的脑炎患者使用相同的问卷进行了评估。回顾性采集患者特征。
在第一队列（平均[标准差]年龄；43[16]岁，220[65%]女性）中，220/338 名参与者（65%）报告疲劳，175/307 名（57%）报告抑郁，211/285 名（74%）报告睡眠质量差。在第二队列（48[19]岁；43[50%]女性）中，42/69 名参与者（61%）报告疲劳，而 23/68 名（34%）报告抑郁，44/66 名（67%）报告睡眠质量差，尽管超过 80%的人具有“良好”改良 Rankin 量表（mRS）评分（0-2）。抗 NMDA 受体脑炎患者的疲劳评分低于其他自身免疫性脑炎类型患者。在一项检查出院时可能预测疲劳评分的因素的多变量分析中，只有抗 NMDA 受体脑炎是疲劳的（负）预测因素，当纳入潜在混杂因素时仍然如此。
自身免疫性脑炎后疲劳的影响显著，抑郁或睡眠质量无法完全解释，mRS 残疾评分也无法充分捕捉。疲劳普遍存在于自身免疫性脑炎中，但抗 NMDA 受体脑炎的评分较低。应常规筛查疲劳，将其视为临床试验的结果测量指标，并从机制角度进一步研究。
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