自身免疫性和感染性脑炎：开发一种具有鉴别能力的工具，用于早期诊断和开始治疗。

Autoimmune and infectious encephalitis: development of a discriminative tool for early diagnosis and initiation of therapy.

机构信息

Department of Neurology, Neurocritical Care, and Neurorehabilitation, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Salzburg, Austria.

Department of Neurology, Kepler University Hospital, Johannes Kepler University, Linz, Austria.

出版信息

J Neurol. 2024 Dec;271(12):7583-7591. doi: 10.1007/s00415-024-12712-7. Epub 2024 Oct 5.

DOI:10.1007/s00415-024-12712-7

PMID:39368009

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11588785/

Abstract

BACKGROUND

Encephalitis originates from diverse autoimmune and infectious etiologies. Diagnostic challenges arise due to the spectrum of presentation and the frequent absence of specific biomarkers. This study aimed to comprehensively characterize and differentiate autoimmune encephalitis (AE) from infectious encephalitis (IE) in adults, and disentangle clinical, paraclinical, and therapeutic differences.

METHODS

A cohort study spanning 10 years was conducted across three Austrian tertiary care hospitals. Inclusion criteria comprised adults with probable or definite encephalitis. Demographics, clinical features, technical findings, treatment modalities, and outcomes were collected from the electronic patient files. A follow-up was performed via telephone interviews and clinical visits.

RESULTS

Of 149 patients, 17% had AE, 73% IE, and 10% encephalitis of unknown etiology. Significant differences between AE and IE included the prevalence of acute symptomatic seizures (AE: 85% vs. IE: 20%, p < 0.001), fever (8% vs. 72%, p < 0.001), headache (15% vs. 61%, p < 0.001), and focal neurological deficits (56% vs. 23%, p = 0.004), respectively. Paraclinical differences comprised lower CSF pleocytosis in AE compared to IE (median 6 cells/µl vs. 125 cells/µl, p < 0.001). Epileptic discharges on EEG and MRI lesions were more prevalent in AE than IE (50% vs. 14%, p < 0.001; 50% vs. 28%, p = 0.037). The modified Rankin Scale scores at discharge and last follow-up (median duration 2304 days, IQR 1433-3274) indicated favorable outcomes in both groups.

CONCLUSION

This comprehensive analysis provides insights into the epidemiology, clinical, paraclinical, and therapeutic aspects and the outcomes of AE and IE in adults. We developed a diagnostic tool that facilitates early differentiation between AE and IE, aiding in timely therapeutic decision-making.

摘要

背景

脑炎源于多种自身免疫性和感染性病因。由于表现谱和经常缺乏特异性生物标志物，诊断面临挑战。本研究旨在全面描述和区分成人自身免疫性脑炎（AE）和感染性脑炎（IE），并理清临床、辅助检查和治疗方面的差异。

方法

对三家奥地利三级保健医院的 10 年队列研究进行了分析。纳入标准为成人疑似或确诊脑炎。从电子病历中收集人口统计学、临床特征、技术检查结果、治疗方式和结局。通过电话访谈和临床访视进行随访。

结果

149 例患者中，17%为 AE，73%为 IE，10%为病因不明的脑炎。AE 和 IE 之间存在显著差异，包括急性症状性癫痫发作的发生率（AE：85% vs. IE：20%，p<0.001）、发热（AE：8% vs. IE：72%，p<0.001）、头痛（AE：15% vs. IE：61%，p<0.001）和局灶性神经功能缺损（AE：56% vs. IE：23%，p=0.004）。辅助检查方面的差异包括 AE 患者 CSF 中白细胞数较 IE 患者低（中位数 6 个/µl vs. 125 个/µl，p<0.001）。脑电图上癫痫放电和 MRI 病变在 AE 中比在 IE 中更常见（AE：50% vs. IE：14%，p<0.001；AE：50% vs. IE：28%，p=0.037）。出院时和最后一次随访时的改良 Rankin 量表评分（中位随访时间 2304 天，IQR 1433-3274）表明两组结局良好。