| Objective The positive rate and clinical characteristics of antibody detection in patients with AE were analyzed retrospectively,and the clinical characteristics and treatment differences of AE patients with positive and negative antibodies were compared.Methods From January 2015 to October 2019,six antibodies against nerve cell surface antigen(anti-NMDAR antibody,anti-LGI1 antibody,anti-GABABR antibody,anti-CASPR2antibody,anti-AMPA1 receptor antibody,anti-AMPA2 receptor antibody)were collected from the General Hospital of Ningxia Medical University and Hospital of Cardiovascular and Cerebrovascular Diseases,and their antibody positive rate and clinical characteristics were analyzed.According to the results of antibody detection,the patients were divided into two groups:positive group and negative group.The general condition,clinical manifestation and auxiliary examination(including CSF,brain MRI,brain EEG),tumor screening and immunosuppressant treatment were compared between the two groups.Results 1.A total of 140antibody patients were tested,including 27 patients with positive antibody AE(19.29%)and 18 patients with negative antibody AE(12.86%).The positive rate of anti-NMDAR encephalitis was the highest(X~2=10.212 P=0.006),and the sensitivity of cerebrospinal fluid(CSF)was higher than that of serum antibody(fisher accurate probability method).2.Among the 27 patients with positive antibody AE,10 had a history of prodromal symptoms and 4 with tumors(1 anti-NMDAR with ovarian teratoma,2 anti-NMDAR encephalitis with uterine leiomyoma,1 anti-GABABR encephalitis with lung cancer).During the course of the disease,there were 19 cases of mental and behavioral abnormalities(13 cases of anti-NMDAR encephalitis,5 cases of anti-LGI1 antibody encephalitis,1 case of anti-GABABR encephalitis),23 cases of seizures(11 cases of anti-NMDAR encephalitis,10cases of anti-LGI1 antibody encephalitis,2 cases of anti-GABABR encephalitis),17 cases of cognitive impairment(8 cases of anti-NMDAR encephalitis,7 cases of anti-LGI1 antibody encephalitis,2 cases of anti-GABABR encephalitis),12 cases of motor dysfunction(6 cases of anti-NMDAR encephalitis,6 cases of anti-LGI1 antibody encephalitis).There were 10cases of disturbance of consciousness(8 cases of anti-NMDAR encephalitis,1 case of anti-LGI1 antibody encephalitis,4 cases of anti-GABABR encephalitis),There were 4 cases of central hypopnea(4 cases of anti-NMDAR encephalitis)and 6 cases of speech dysfunction(5 cases of anti-NMDAR encephalitis and 1 case of anti-GABABR encephalitis).3.There was no significant difference in general condition,clinical features and auxiliary examination(except antibody detection)between the two groups.The mRS score was significantly improved in the positive antibody AE group before and after the main use of immunosuppressant treatment(U=113.00P=0.042),and also significantly improved in the negative antibody AE group(U=83.500P=0.008).Conclusion 1.Among the six surface AE antibody tests submitted for examination,the positive rate of NMDAR antibody was the highest,and the sensitivity of CSF in anti-NMDAR encephalitis was higher than that of serum antibody.2.The first symptoms and clinical manifestations of AE patients with different antibodies are different:(1)Anti-NMDAR encephalitis starts with headache and fever,which is common in young women,often accompanied by gynecologic tumors,manifested as abnormal mental behavior,seizures,cognitive impairment,etc.(2)The symptoms of anti-LGI1 antibody encephalitis precursor infection were obvious,and most of them were middle-aged and old-aged men,manifesting as seizures,cognitive dysfunction,FBDS and hyponatremia.(3)Anti-GABABR antibody encephalitis starts with epilepsy and cognitive dysfunction,which are common in middle-aged and middle-aged patients,and often complicated with small cell lung cancer.3.There is no significant difference in clinical characteristics between AE patients with positive antibody and AE patients with negative antibody.Immunotherapy(hormone and C-ball)is effective,so it is necessary to give immunosuppressive therapy to AE patients with suspected negative antibody. |
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