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自身免疫性脑炎相关不同抗体的临床特点。

Features of the clinical course of Autoimmune Encephalitis Associated with various antibodies.

机构信息

Department of Biology and General Genetics, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.

Department of Internal Diseases № 1, Non-Commercial Joint-Stock Society «West Kazakhstan Marat Ospanov Medical University», Aktobe, Kazakhstan.

出版信息

Neurol Sci. 2024 Nov;45(11):5413-5421. doi: 10.1007/s10072-024-07604-7. Epub 2024 May 28.

Abstract

Despite the increasing incidence of autoimmune encephalitis and the incomplete recovery observed in patients post-affliction, the issue of timely diagnosis remains unresolved. The primary objective of this study is identification the distinctive clinical presentation features evaluation the management strategies, and assess the outcomes of the disease in patients with various forms of autoimmune encephalitis. The research aims to contribute in a better understanding of the disease progression and facilitate the selection of optimal therapeutic interventions. A retrospective observational study enrolled 68 patients aged 18 years and older with verified autoimmune encephalitis who underwent treatment in state hospitals in Sofia, Bulgaria, from the beginning of 2014 to the end of 2022. The number of patients with pathology linked to antibodies against glycine receptors (Gly-R) was half as much, with 32 and 17 patients, respectively. The primary manifestations of autoimmune encephalitis included cognitive impairments observed in 51 patients, seizures occurring in 44 patients, and mood disorders observed in 22 patients. While the findings of imaging studies were nonspecific, hospitalizations for patients with this pathology, especially those with antibodies to CASPR2 and DPPX, were prolonged (114 and 232 days, respectively). In the vast majority of cases, incomplete recovery with residual symptoms was noted. Among the diverse forms of autoimmune encephalitis, the most prevalent is NMDA-R. Cognitive impairments predominate in the autoimmune encephalitis clinical presentation. Prolonged hospitalization periods and incomplete recovery of patients are characteristic features of autoimmune encephalitis, despite combined therapy involving intravenous administration of methylprednisolone and immunoglobulins.

摘要

尽管自身免疫性脑炎的发病率不断增加,且患者在发病后恢复不完全,但及时诊断的问题仍未得到解决。本研究的主要目的是确定自身免疫性脑炎不同类型患者的独特临床表现,评估治疗策略,并评估疾病的结局。该研究旨在更好地了解疾病进展并为选择最佳治疗干预措施提供帮助。这是一项回顾性观察性研究,纳入了 2014 年初至 2022 年底在保加利亚索非亚州医院接受治疗的 68 名年龄在 18 岁及以上的自身免疫性脑炎确诊患者。与抗甘氨酸受体(Gly-R)抗体相关的患者数量减少了一半,分别为 32 名和 17 名。自身免疫性脑炎的主要表现包括 51 名患者认知障碍、44 名患者癫痫发作和 22 名患者情绪障碍。尽管影像学研究结果无特异性,但患有这种病理的患者住院时间延长,尤其是那些抗 CASPR2 和 DPPX 抗体的患者,分别为 114 天和 232 天。在绝大多数情况下,患者的恢复不完全,仍存在残留症状。在各种形式的自身免疫性脑炎中,最常见的是 NMDA-R。认知障碍是自身免疫性脑炎的主要临床表现。尽管联合使用静脉注射甲基强的松龙和免疫球蛋白进行治疗,但患者的住院时间延长和恢复不完全是自身免疫性脑炎的特征。

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