Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Jiangsu, Nanjing, China.
Front Immunol. 2024 Mar 1;15:1299898. doi: 10.3389/fimmu.2024.1299898. eCollection 2024.
The objective of this study was to elucidate the contribution of cerebrospinal fluid (CSF) antibody titers (AT) and sex to acute cerebral blood flow (CBF) in patients diagnosed with anti--methyl-d-aspartate receptor autoimmune encephalitis (NMDAR AE).
Forty-five patients diagnosed with NMDAR AE were recruited from December 2016 to January 2023. The acute CBF in patients with NMDAR AE at the early stage of the disease was analyzed using arterial spin labeling. The groups were compared based on CSF AT and sex. The connectivity of the CBF in the region of interest was also compared between groups.
The patients with different CSF AT exhibited varied brain regions with CBF abnormalities compared to the healthy subjects ( = 0.001, cluster-level FWE corrected). High antibody titers (HAT) in CSF contributed to more brain regions with CBF alterations in female patients than in female patients with low antibody titers (LAT) in CSF ( = 0.001, cluster-level FWE corrected). Female patients with HAT in CSF displayed more decreased CBF in the left post cingulum gyrus, left precuneus, left calcarine, and left middle cingulum gyrus than the male patients with the same AT in CSF ( = 0.001, cluster-level FWE corrected). All patients with NMDAR AE showed increased CBF in the left putamen (Putamen_L) and left amygdala (Amygdala_L) and decreased CBF in the right precuneus (Precuneus_R), which suggests that these are diagnostic CBF markers for NMDAR AE.
CSF AT and sex contributed to CBF abnormalities in the patients diagnosed with NMDAR AE. Altered CBF might potentially serve as the diagnostic marker for NMDAR AE.
本研究旨在阐明脑脊液（CSF）抗体滴度（AT）和性别对诊断为抗 N-甲基-D-天冬氨酸受体自身免疫性脑炎（NMDAR AE）患者急性脑血流（CBF）的影响。
从 2016 年 12 月至 2023 年 1 月，共招募了 45 名诊断为 NMDAR AE 的患者。使用动脉自旋标记分析 NMDAR AE 患者疾病早期的急性 CBF。根据 CSF AT 和性别对患者进行分组比较。还比较了各组间感兴趣区 CBF 的连通性。
与健康受试者相比，具有不同 CSF AT 的患者表现出不同的脑区 CBF 异常（ = 0.001，簇级 FWE 校正）。CSF 中高抗体滴度（HAT）的女性患者比 CSF 中低抗体滴度（LAT）的女性患者脑区 CBF 改变更多（ = 0.001，簇级 FWE 校正）。CSF 中 HAT 的女性患者与具有相同 CSF AT 的男性患者相比，左侧后扣带回、左侧楔前叶、左侧距状回和左侧中扣带回的 CBF 降低更为明显（ = 0.001，簇级 FWE 校正）。所有 NMDAR AE 患者均表现为左侧壳核（Putamen_L）和左侧杏仁核（Amygdala_L）CBF 增加，右侧楔前叶（Precuneus_R）CBF 降低，提示这些是 NMDAR AE 的诊断性 CBF 标志物。
CSF AT 和性别导致诊断为 NMDAR AE 的患者 CBF 异常。改变的 CBF 可能是 NMDAR AE 的诊断标志物。
