Cheng Xuan, Li Yimeng, Wang Yaoyao, Sun Yidi, Lian Yajun
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
J Neuroimmunol. 2023 Oct 15;383:578203. doi: 10.1016/j.jneuroim.2023.578203. Epub 2023 Sep 19.
Blood-brain barrier (BBB) breakdown is an essential mechanism in inflammatory diseases of the central nervous system. However, the association between BBB integrity and autoimmune encephalitis (AE) has not been investigated. Our study aimed to analyze this relationship in patients with AE between BBB integrity with clinical manifestations and therapeutic responses.
Our study enrolled 147 patients with AE who were newly diagnosed at the First Affiliated Hospital of Zhengzhou University between August 2015 and December 2021. Patients were classified into normal or damaged BBB groups based on cerebrospinal fluid (CSF) albumin/serum albumin (QAlb). To evaluate the severity of the illness, we used the modified Rankin Scale (mRS) and the Clinical Assessment Scale for Autoimmune Encephalitis (CASE).
We found a higher proportion of males, higher CSF protein, immunoglobulin IgG, and 24-h intrathecal IgG synthesis rate in the damaged BBB group. The improvement rate was lower in the damaged BBB group, but we found that double- or triple-combination immunotherapy had better clinical outcomes than single immunotherapy. In addition, there was a positive correlation between the CASE score and mRS score, and a positive correlation between the CASE score or mRS score and QAlb on admission.
BBB integrity is closely related to the clinical features and treatment responses of newly diagnosed AE. Patients with AE and a damaged BBB may benefit from combination immunotherapy.
血脑屏障（BBB）破坏是中枢神经系统炎症性疾病的一个重要机制。然而，BBB完整性与自身免疫性脑炎（AE）之间的关联尚未得到研究。我们的研究旨在分析AE患者中BBB完整性与临床表现及治疗反应之间的这种关系。
我们的研究纳入了2015年8月至2021年12月期间在郑州大学第一附属医院新诊断的147例AE患者。根据脑脊液（CSF）白蛋白/血清白蛋白（QAlb）将患者分为BBB正常或受损组。为评估疾病严重程度，我们使用了改良Rankin量表（mRS）和自身免疫性脑炎临床评估量表（CASE）。
我们发现BBB受损组男性比例更高，CSF蛋白、免疫球蛋白IgG及24小时鞘内IgG合成率更高。BBB受损组的改善率较低，但我们发现双重或三联免疫疗法比单一免疫疗法具有更好的临床效果。此外，CASE评分与mRS评分之间呈正相关，入院时CASE评分或mRS评分与QAlb之间呈正相关。
BBB完整性与新诊断AE的临床特征和治疗反应密切相关。BBB受损的AE患者可能从联合免疫疗法中获益。
