Tang Xuhui, Liu Yu, Zhou Gaoya, Tu Ewen, Yu Cheng, Xiong Meishan, Lin Cong
Department of Neurology, The Second People's Hospital of Hunan Province, Brain Hospital of Hunan Province, Changsha, China.
Department of Neurology, College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, China.
Front Immunol. 2025 Aug 12;16:1602047. doi: 10.3389/fimmu.2025.1602047. eCollection 2025.
To compare the differential effects of intravenous immunoglobulin (IVIg) and protein A immunoadsorption (PAIA) on neurological functional improvement in patients with severe anti-NMDAR encephalitis.
We retrospectively evaluated patients with severe anti-NMDAR encephalitis (modified Rankin scale, mRS ≥ 3) at the Second People's Hospital of Hunan from January 1, 2019, to December 31, 2024. Clinical efficacy was compared between the IVIg and PAIA groups. Clinical improvement (ΔmRS ≥ 1) and favorable functional outcomes (mRS 0-2) at 30 days and 90 days were evaluated as primary outcomes. Secondary outcomes included changes in mRS and the Clinical Assessment Scale for Autoimmune Encephalitis (ΔCASE) at 30 and 90 days, length of ICU stay, and antibody titers in cerebrospinal fluid (CSF) and serum.
This study enrolled 53 patients with severe anti-NMDAR encephalitis, of whom 30 patients received IVIg and 23 patients received PAIA. The PAIA group showed a significantly higher rate of clinical improvement at 30 days after treatment compared to the IVIg group (82.61% . 50%, = 0.014). However, no significant difference was found at 90 days after treatment (95.65% 96.67%, > 0.05). Furthermore, favorable functional outcomes at 30 days (17.39% 6.67%) and 90 days (91.30% 80.00%) showed no significant differences between the two groups ( > 0.05). Significant differences were observed in ΔmRS ( = 0.005), ΔmRS ( = 0.03), and ΔCASE ( = 0.027), but not in ΔCASE ( > 0.05). PAIA was associated with a greater reduction in antibody titers in both CSF and serum and a shorter ICU stay.
Our study demonstrates that both IVIg and PAIA are effective treatments for patients with severe anti-NMDAR encephalitis. However, PAIA demonstrates several distinct advantages, including earlier clinical improvement, faster antibody clearance, and a potential reduction in ICU stay.
比较静脉注射免疫球蛋白（IVIg）和蛋白A免疫吸附（PAIA）对重症抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者神经功能改善的不同效果。
我们回顾性评估了2019年1月1日至2024年12月31日在湖南省第二人民医院就诊的重症抗NMDAR脑炎患者（改良Rankin量表，mRS≥3）。比较IVIg组和PAIA组的临床疗效。将30天和90天时的临床改善（ΔmRS≥1）和良好功能结局（mRS 0-2）作为主要结局。次要结局包括30天和90天时mRS的变化以及自身免疫性脑炎临床评估量表（ΔCASE）、重症监护病房（ICU）住院时间，以及脑脊液（CSF）和血清中的抗体滴度。
本研究纳入了53例重症抗NMDAR脑炎患者，其中30例接受IVIg治疗，23例接受PAIA治疗。与IVIg组相比，PAIA组治疗后30天时临床改善率显著更高（82.61%对50%，P = 0.014）。然而，治疗90天时未发现显著差异（95.65%对96.67%，P>0.05）。此外，两组在30天（17.39%对6.67%）和90天（91.30%对80.00%）时的良好功能结局无显著差异（P>0.05）。在ΔmRS（P = 0.005）、ΔmRS（P = 0.03）和ΔCASE（P = 0.027）方面观察到显著差异，但在ΔCASE方面未观察到显著差异（P>0.05）。PAIA与CSF和血清中抗体滴度的更大降低以及更短的ICU住院时间相关。
我们的研究表明，IVIg和PAIA都是治疗重症抗NMDAR脑炎患者的有效方法。然而，PAIA显示出几个明显的优势，包括更早的临床改善、更快的抗体清除以及ICU住院时间可能缩短。
