Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Front Immunol. 2022 Aug 25;13:918064. doi: 10.3389/fimmu.2022.918064. eCollection 2022.
Anti-gamma-aminobutyric-acid type B receptor (anti-GABAR) encephalitis is a rare autoimmune condition caused by the presence of GABAR antibodies in the limbic system. However, its clinical features and prognostic factors are poorly understood. In this study, we aimed to explore factors that affect the response to first-line treatment in patients with anti-GABAR encephalitis.
Thirty-four patients with an initial diagnosis of anti-GABAR encephalitis were retrospectively enrolled from December 2015 to June 2021. Clinical features and experimental data recorded within 24 h of admission were extracted from the patients' medical records. The modified Rankin Scale (mRS) was utilized to assess disease severity at admission and functional recovery after immunotherapy. Independent prognostic factors were determined by ordinal logistic regression analysis.
Of the 34 anti-GABAR encephalitis patients, 12 (35%) presented with cancer; all of these patients had lung cancer. According to multivariate regression analysis, the cancer group exhibited a decrease in the peripheral blood absolute lymphocyte count (ALC) (odds ratio [OR]: 0.063, 95% confidence interval [CI]: 0.006-0.639, P=0.019) and hyponatremia (OR: 9.268, 95% CI: 1.054-81.502, 0.045). In addition, the neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR) and platelet/lymphocyte ratio (PLR) did not significantly differ according to mRS scores in patients receiving first-line treatment. No patients with mild or moderate mRS scores (0-2) at admission developed symptoms after treatment; in contrast, only 11 patients with a severe mRS scores (≥3, 11/18) experienced symptom alleviation. Ordinal regression analysis indicated that worse prognosis was associated with pulmonary infection (OR=9.885, 95% CI: 1.106-88.323, P=0.040) and baseline mRS scores (OR= 24.047, 95% CI: 3.294-175.739, P=0.002) in the adjusted model.
Our findings demonstrate that pulmonary infection and baseline mRS scores are independent risk factors for poor prognosis in patients with anti-GABAR encephalitis after first-line treatment. ALC and hyponatremia are potential biomarkers for anti-GABAR encephalitis cases accompanied by lung cancer.
抗γ-氨基丁酸 B 型受体（anti-GABAR）脑炎是一种罕见的自身免疫性疾病，由边缘系统中存在 GABAR 抗体引起。然而，其临床特征和预后因素仍不清楚。本研究旨在探讨影响抗-GABAR 脑炎患者一线治疗反应的因素。
回顾性纳入 2015 年 12 月至 2021 年 6 月期间确诊为抗-GABAR 脑炎的 34 例患者。从患者病历中提取入院 24 小时内记录的临床特征和实验数据。采用改良 Rankin 量表（mRS）评估入院时的疾病严重程度和免疫治疗后的功能恢复情况。采用有序逻辑回归分析确定独立的预后因素。
34 例抗-GABAR 脑炎患者中，12 例（35%）伴发癌症；所有患者均为肺癌。多变量回归分析显示，癌症组的外周血绝对淋巴细胞计数（ALC）（比值比[OR]：0.063，95%置信区间[CI]：0.006-0.639，P=0.019）和低钠血症（OR：9.268，95%CI：1.054-81.502，P=0.045）减少。此外，在接受一线治疗的患者中，根据 mRS 评分，中性粒细胞/淋巴细胞比值（NLR）、单核细胞/淋巴细胞比值（MLR）和血小板/淋巴细胞比值（PLR）无显著差异。入院时 mRS 评分（0-2）为轻度或中度的患者无治疗后症状加重；而只有 mRS 评分（3-18）为重度的 11 例患者出现症状缓解。有序回归分析表明，肺部感染（OR=9.885，95%CI：1.106-88.323，P=0.040）和基线 mRS 评分（OR=24.047，95%CI：3.294-175.739，P=0.002）是调整模型中预后不良的独立危险因素。
本研究结果表明，肺部感染和基线 mRS 评分是抗-GABAR 脑炎患者一线治疗后预后不良的独立危险因素。ALC 和低钠血症可能是伴发肺癌的抗-GABAR 脑炎的潜在生物标志物。
