Gong Zhuowei, Lao Dayuan, Huang Fang, Lv Sirao, Mao Fengping, Huang Wen
Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.
Patient Relat Outcome Meas. 2023 Jun 14;14:181-192. doi: 10.2147/PROM.S411260. eCollection 2023.
Disturbance of consciousness is common in patients with severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. However, little is known about it. This study aimed to analyze the clinical manifestations and prognostic factors of anti-NMDAR encephalitis with disturbance of consciousness.
In this retrospective study, the clinical features, treatment results, and long-term outcomes of anti-NMDAR encephalitis patients with disturbance of consciousness were analyzed, and multivariate logistic regression was used to analyze the factors affecting their prognosis.
In the group with disturbance of consciousness, the incidences of seizures, involuntary movements, pulmonary infection, mechanical ventilation, intensive care unit (ICU) admission, neutrophil-lymphocyte ratio (NLR), abnormal cerebrospinal fluid index, plasma exchange, and immunosuppressive therapy were higher than those in the group without disturbance of consciousness (all P<0.05). During the follow-up period (median: 36 months, range: 12-78 months), the modified Rankin scale (mRS) score, the maximum mRS score during hospitalization, the mRS score at discharge, and the mRS score at 12 months after discharge were higher in the disturbance of consciousness group (all P < 0.001). However, there was no significant difference in long-term outcomes and recurrence between the two groups. Multivariate logistic regression analysis showed that mechanical ventilation, elevated IgG index, and delayed immunotherapy were independent risk factors for poor outcomes in patients with anti-NMDAR encephalitis with disturbance of consciousness at 12 months (odds ratio: 22.591, 39.868, 1.195). The receiver operating characteristics (ROC) curve analysis showed that the area under the curve (AUC) of mechanical ventilation, elevated IgG index, and delayed immunotherapy was 0.971 (95% CI=0.934-1.000, P<0.001).
Mechanical ventilation, elevated IgG index, and delayed immunotherapy may be the influencing factors of poor prognosis of anti-NMDAR encephalitis patients with disturbance of consciousness. Although their condition is relatively serious, most patients with anti-NMDAR encephalitis with disturbance of consciousness will achieve favorable long-term outcomes after long-term treatment.
意识障碍在重症抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者中很常见。然而，对此了解甚少。本研究旨在分析伴有意识障碍的抗NMDAR脑炎的临床表现及预后因素。
在这项回顾性研究中，分析了伴有意识障碍的抗NMDAR脑炎患者的临床特征、治疗结果及长期预后，并采用多因素逻辑回归分析影响其预后的因素。
在意识障碍组中，癫痫发作、不自主运动、肺部感染、机械通气、入住重症监护病房（ICU）、中性粒细胞与淋巴细胞比值（NLR）、脑脊液指标异常、血浆置换及免疫抑制治疗的发生率均高于无意识障碍组（均P<0.05）。随访期间（中位数：36个月，范围：12 - 78个月），意识障碍组的改良Rankin量表（mRS）评分、住院期间最高mRS评分、出院时mRS评分及出院后12个月mRS评分均更高（均P < 0.001）。然而，两组的长期预后及复发情况无显著差异。多因素逻辑回归分析显示，机械通气、IgG指数升高及免疫治疗延迟是伴有意识障碍的抗NMDAR脑炎患者12个月时预后不良的独立危险因素（比值比：22.591、39.868、1.195）。受试者工作特征（ROC）曲线分析显示，机械通气、IgG指数升高及免疫治疗延迟的曲线下面积（AUC）为0.971（95%CI = 0.934 - 1.000，P<0.001）。
机械通气、IgG指数升高及免疫治疗延迟可能是伴有意识障碍的抗NMDAR脑炎患者预后不良的影响因素。虽然其病情相对严重，但大多数伴有意识障碍的抗NMDAR脑炎患者经长期治疗后可获得良好的长期预后。
