Liu Fei, Zhang Bingbing, Huang Teng, Wang Baojie, Wang Chunjuan, Hao Maolin, Guo Shougang
Department of Neurology, Shandong Second Provincial General Hospital, Jinan, China.
Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Front Neurol. 2022 Apr 14;13:861988. doi: 10.3389/fneur.2022.861988. eCollection 2022.
This study was performed to assess the potential factors for poor short-term first-line treatment response, the appropriate further treatment options, and the prognosis in patients with autoimmune encephalitis (AE).
This retrospective study consisted of 135 patients with AE. According to their short-term first-line treatment response, patients were divided into the response group and the non-response group. The demographics, clinical characteristics, main accessory examinations, immunotherapy, and outcomes of patients were compared between the two groups. Univariate and multivariate logistic regression models were used to analyze whether non-responders have poor long-term outcomes. Further treatment and prognosis of non-responders were also analyzed.
Of the 128 patients who were treated with first-line immunotherapy, 59 (46.1%) were non-responders. Patients in the non-response group had more symptoms and exhibited a higher proportion of mental behavior disorder, central hypoventilation, and autonomic nervous dysfunction. The modified Rankin scale (mRS) scores and neutrophil-to-lymphocyte ratio (NLR) levels were significantly higher and albumin, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A (apoA) levels were significantly lower in the non-response group ( < 0.05, all). Multivariate logistic regression analysis showed that the number of clinical symptoms, mental behavior disorder, central hypoventilation, maximum mRS score, and albumin level was independently associated with non-response to short-term first-line treatment. Non-responders had poor long-term outcomes compared with the responders at all times of followed-up ( < 0.05, all). In multivariable analysis, initial first-line treatment response was independently associated with the long-term prognosis, both at 12-month [odds ratio (OR), 4.74, 95% CI, 1.44-15.59, and =0.010] and 24-month follow-ups (OR, 8.81, 95% CI, 1.65-47.16; and = 0.011). Among the non-responders, a higher improvement of mRS scores was observed in those who received second-line treatment than those who had no further treatment or repetition of first-line immunotherapy in the follow-up. However, the rate of a good outcome and median mRS scores were not significantly different among the three groups.
Disease severity, clinical features, anti-N-methyl-D-aspartate receptor subtypes, antibody titers, NLR, albumin, HDL-C, and apoA levels were all associated with non-response to short-term first-line treatment. The short-term first-line treatment response is a valuable predictor of long-term outcomes in patients with AE. Second-line immunotherapy may be a more aggressive treatment option for patients who failed short-term first-line immunotherapy.
本研究旨在评估自身免疫性脑炎（AE）患者短期一线治疗反应不佳的潜在因素、合适的进一步治疗方案及预后情况。
本回顾性研究纳入了135例AE患者。根据短期一线治疗反应，将患者分为反应组和无反应组。比较两组患者的人口统计学特征、临床特点、主要辅助检查、免疫治疗及结局。采用单因素和多因素逻辑回归模型分析无反应者是否具有不良的长期结局。同时分析无反应者的进一步治疗及预后情况。
在128例接受一线免疫治疗的患者中，59例（46.1%）为无反应者。无反应组患者症状更多，精神行为障碍、中枢性通气不足及自主神经功能障碍的比例更高。无反应组改良Rankin量表（mRS）评分及中性粒细胞与淋巴细胞比值（NLR）水平显著更高，白蛋白、高密度脂蛋白胆固醇（HDL-C）、载脂蛋白A（apoA）水平显著更低（均P<0.05）。多因素逻辑回归分析显示，临床症状数量、精神行为障碍、中枢性通气不足、最高mRS评分及白蛋白水平与短期一线治疗无反应独立相关。在所有随访时间点，无反应者与反应者相比长期结局均较差（均P<0.05）。多变量分析中，初始一线治疗反应在12个月[比值比（OR）为4.74，95%置信区间（CI）为1.44 - 15.59，P = 0.010]和24个月随访时（OR为8.81，95%CI为1.65 - 47.16；P = 0.011）均与长期预后独立相关。在无反应者中，随访期间接受二线治疗者较未进一步治疗或重复一线免疫治疗者mRS评分改善更高。然而，三组间良好结局率及mRS评分中位数无显著差异。
疾病严重程度、临床特征、抗N-甲基-D-天冬氨酸受体亚型、抗体滴度、NLR、白蛋白、HDL-C及apoA水平均与短期一线治疗无反应相关。短期一线治疗反应是AE患者长期结局的重要预测指标。二线免疫治疗可能是短期一线免疫治疗失败患者更积极的治疗选择。
