| Background and objectiveIn recent ten years,with the continuous development of antibody detection technology,immune-mediated encephalitis has become a research topic.Immunemediated encephalitis is collectively referred to as autoimmune encephalitis.Among the subtypes,anti-N-methyl-D-aspartate receptor（NMDAR）encephalitis is the most common,with various clinical manifestations and varying severity.Anti-NMDAR encephalitis accounts for a high proportion of severe neurological encephalitis of unknown cause.Severe anti-NMDAR encephalitis usually has a long hospital stay,high cost,and poor prognosis,but there is still a lack of effective markers for evaluating the condition and prognosis of severe anti-NMDAR encephalitis.The level of thyroxine is related to the condition and prognosis of many severe neurological and neurological immune diseases.The aim of this study was to analyze the changes of Cerebrospinal fluid（CSF）assay and some serological indicators during severe and non-severe anti-NMDAR encephalitis and its relationship with the prognosis of severe anti-NMDAR encephalitis.Materials and methodsProspectively register the cases data of patients diagnosed with anti-NMDAR encephalitis in Zhengzhou University People’s Hospital from January 2017 to May 2020,including general information,clinical features,auxiliary examinations,CSF routines,biochemistry,cytology,thyroid hormone levels and antibody detection,cytokines and other biochemical indicators.According to whether the patients were diagnosed for the first time,the patients were divided into the relapse group and the first diagnosis group,and the clinical characteristics and CSF test results between the two groups were compared and analyzed;According to whether the patients were severe,they were divided into severe group and non-severe group,and the characteristics of changes in CSF tests and serological indicators between the two groups were analyzed;Patients were followed up after discharge（mainly telephone or outpatient follow-up）once every 3 months for at least 1 year and their neurological function was scored using the Modified Rankin Scale（mRS）;The prognosis of patients with severe anti-NMDAR encephalitis was evaluated according to mRS score at 1 year of follow-up,mRS≤2 points indicated good prognosis,and mRS>2 points indicated poor prognosis.The patients with severe anti-NMDAR encephalitis were divided into good prognosis group and poor prognosis group,and the clinical data of the two groups were compared and the indicators with differences in single factor comparison between the two groups were entered into the binary logistic regression analysis to obtain independent risk factors that affected the prognosis of severe anti-NMDAR encephalitis.Serum and CSF cytokines of patients before immunotherapy and 1 month after immunotherapy were paired to analyze the changes.Results1.A total of 75 patients with anti-NMDAR encephalitis were included in this study,and all patients were positive for anti-NMDAR antibodies in the CSF.There were 19 cases（25.3%）in the relapse group and 56 cases（74.7%）in the first diagnosis group,and there was no difference in age and gender between the two groups（P>0.05）.The proportion of abnormal EEG and median length of hospital stay in the relapsed group were lower than those in the first diagnosis group,and the comparison between the two groups was statistically significant（P=0.018,P=0.02）.The proportion of diplopia and central nervous system demyelinating antibodies in relapsed group was higher than that in the first diagnosis group,and the comparison between the two groups was statistically significant（P=0.017、P=0.047）.2.Among the 75 patients with anti-NMDAR encephalitis,24 cases（32%）were severe,and there was no statistically significant difference between the severe group and the non-severe group in terms of age and gender（P>0.05）;The severe group accounted for a higher proportion of high antibody titers in CSF,and the comparison between the two groups was statistically significant（P=0.04）;The levels of serum albumin,T4 and FT3 in the severe group were significantly lower than those in the non-severe group,and the comparison between the two groups was statistically significant（P=0.007,P=0.000,P=0.013）;Binary Logistic regression analysis suggested that T4 was an independent risk factor for predicting the severity of antiNMDAR encephalitis.3.After 1 year of follow-up,among the 24 patients with severe anti-NMDAR encephalitis,15 patients（62.5%）had good prognosis and 9 patients（37.5%）had poor prognosis.The levels of T4 and FT3 in the poor prognosis group were significantly lower than those in the good prognosis group,and the comparison between the two groups was statistically significant（P=0.003,P=0.016）;The median mRS score in the poor prognosis group was higher than that in the good prognosis group at peak,and the comparison between the two groups was statistically significant（P=0.046）;Binary Logistic regression analysis suggested that T4 was an independent risk factor for predicting the prognosis of severe anti-NMDAR encephalitis.4.CSF cytokines were detected in 12 patients before and 1 month after immunotherapy,and IL-6 levels in CSF decreased after immunotherapy,which was statistically significant compared with before immunotherapy（P=0.002）.Serum cytokines were detected in 15 patients before and 1 month after immunotherapy,and serum IL-6 and IL-4 levels decreased after immunotherapy,which were statistically significant compared with before immunotherapy（P=0.002,P=0.003）.Conclusion1.Patients with relapse anti-NMDAR encephalitis are mildly ill,and often combined with central nervous system demyelinating antibodies.2.Low serum albumin,T4 and FT3 may indicate the severity of anti-NMDAR encephalitis,and T4 is an independent risk factor for predicting the severity of antiNMDAR encephalitis.3.T4 is an independent risk factor for predicting the prognosis of patients with severe anti-NMDAR encephalitis.4.CSF and serum IL-6 are related to the occurrence and development of antiNMDAR encephalitis,and serum IL-4 may be related to the occurrence and development of anti-NMDAR encephalitis. |
PDF Full Text Request