| Objective:1.We summarized the clinical characteristics of 125 autoimmune encephalitis patients with antibody.2.We analyzed the probable risk factor of severe autoimmune encephalitis.3.We established the prediction model of severe encephalitis in AE patients and tested its prediction effectiveness.Methods:We retrospectively analyzed the clinical data of antibody-positive AE patients who visited the First hospital of Jilin University from September 2019 to November 2021,including age,sex,clinical symptoms,auxiliary examination results and treatment.Then we analyzed the probable risk factors of severe AE patients by using statistics method and established the predictive model of severe AE and tested its effectiveness.Results:1.Among the total 125 AE patients,males accounted for 48.8%（61 cases）and females accounted for 51.2%（64 cases）.In this study,female patients with NMDAR subtype and LGIl subtype were significantly more than male patients,accounting for62.5% and 60% respectively,and the onset age ranged from 15 to 86 years old,with an average age of 47 years old.2.Among the total 125 patients,the proportion of each subtype is NMDAR 32%（40 cases）,LGI1 28%（35 cases）,GABA 12.8%（16 cases）,GAD65 8%（10 cases）,CASPR2 4.8%（6 cases）,GFAP 4%（5 cases）,AMPAR 1.6%（2 cases）,the subtype with multiple positive antibody 6.4%（8 cases）and rare subtype 2.4%（each of mGlu R5,CV2 and IgLON5 has 1 case）,respectively.3.In this study,22.4%（27 cases）of the patients had prodromal symptoms before onset,mainly including fever,headache,nausea and gastrointestinal discomfort.The proportion of initial symptoms was epileptic seizure 46.4%（58 cases）,abnormal mental behavior 22.4%（28 cases）,cognitive impairment 15.2%（19 cases）,dizziness and headache 11.2%（14 cases）,and other rare symptoms 4.8%（6 cases）,including insomnia,vision problem and numbness of limb.58%（73 cases）of all patients have cognitive impairment,58%（72 cases）have abnormal mental behavior,54%（68cases）have seizure,42%（52 cases）have sleep problems,15%（19 cases）have autonomic nerve dysfunction,5%（6 cases）have central hypoventilation and 3%（4cases）have peripheral nerve symptoms in the course of the disease.4.In our study,79 cases have taken electroencephalogram test,and 86.1%indicates abnormal,including focal discharge and low function of brain.116 cases have made MRI scanning,46.6%（54 cases）shows abnormal signals,mostly in hippocampus and temporal lobe.5.18 cases of the total patients have be detected with tumor,accounting for 14.4%,and the multiple positive antibody group has a high tumor rate of 50%（4 cases）,then NMDAR 20%（8 cases）,GAD65 20%（2 cases）,GABA 19%（3 cases）and LGI10.8%（1 case）,including 9 cases of teratoma of ovary,8 cases of small cell lung cancer and 1 case of adenocarcinoma of lung.No tumors have been detected in other subtypes.6.44%（55 cases）of 125 patients developed severe encephalitis,among which GAD65 have the highest severe rate（70%）,followed by CASPR2 67%（4 cases）,NMDAR 60%（24 cases）,GABA 56%（9 cases）,and multiple antibody positive 50%（4 cases）.AMPAR 50%（1 case）,GFAP 40%（2 cases）,LGI1 19%（4 cases）and rare type 3 patients did not develop to severe encephalitis.7.Among the 125 patients included in this study,there were 55 severe encephalitis patients and 70 non-severe encephalitis patients.Univariate analysis suggested that the age,absolute value of eosinophil,albumin,high density lipoprotein cholesterol,the leukocyte count in cerebrospinal fluid,merged with tumor,MHR,NHR,the grade of serum antibodies,prodromal symptoms,mRS at admission and abnormal mental behavior were risk factors for the development of severe encephalitis in AE patients.Severe AE group,average age is lower（40.47± 18.07vs52.14 ±16.96）,albumin level in serum is lower（36.49±4.24ws38.10397）,eosinophil level was lower [0.04（0.01-0.08）vs0.06（0.03-0.16）],HDL-C level is lower（0.9940.26vs1.28±0.49）,leukocyte in cerebrospinal fluid is higher [17.0（4.0-43.0）vs5.0（2.5-15.5）],MHR is lower[0.47（0.35-0.61）vs0.65（0.39-0.89）],NHR is lower [4.13（3.31-5.48）vs6.09（4.11-9.34）],the rate of merged with tumor is higher in severe patients（p <0.05）,the incidence rate of prodromal symptoms is higher（p <0.05）,mRS score grade is higher at admission（p <0.05）,and the frequency of abnormal mental behavior is higher（p<0.05）.8.Multivariate analysis of the severe AE patients group shows that mRS score and HDL-C at admission are independent influence factors of severe AE patients group,and HDL-C level was negatively correlated with the severity of AE（OR 0.00595%CI 0.003-0.816,p =0.035<0.05）.9.According to ROC calculation,HDL-C value at 1.115 mmo L was the cut-off value for predicting the development of severe AE patients.The area under the curve was 0.728,and the 95% confidence interval（95%CI）was 0.638-0.819,p <0.001.The sensitivity and specificity were 79.2% and 56.9% respectively.In conclusion,the level of HDL-C< 1.115 mmol/L could predict that the AE patients probably develop to severe encephalitis.mRS score >3 at admission is more likely to develop severe encephalitis,and there was statistical difference between mRS ≤3 and mRS >3 at admission in the development of severe encephalitis.10.Taking the group of both low-risk of mRS grade and HDL-C as the control group,the risk of exposure to low HDL-C level alone is 10.364 times（p <0.05）;the risk of exposure to high mRS grade alone is 10.556 times（p <0.05）;the risk of exposure to dual risk factors of low HDL-C level and high mRS grade score is 42.75 times,p <0.001.The AUC and 95%CI followed by HDL-C 0.728（95%CI0.638-0.819）,mRS grade 0.674（95%CI 0.579-0.768）and predictive model 0.755（95%CI 0.668-0.842）.Conclusion:1.This study indicates that anti-NMDAR and anti-LGI1 types are the dominant types in AE patients,and there was no difference in gender.The regular prodromal symptom includes epileptic seizure,abnormal mental behavior,cognitive impairment and headache.Autonomic nerve dysfunction,central hypoventilation and peripheral nerve dysfunction also appear in some patients.EEG and head MRI scanning of AE patients don’t show specific changes,the former mostly show focal discharge and decline of global brain function,while the latter mostly show non-specific abnormal signals in hippocampus and temporal lobe.Patients with AE can be emerged with tumor.In multiple antibody positive group,the possibility of complicated tumor is increased.AE patients can develop into severe encephalitis,and the incidence of severe encephalitis varies in different types,GAD65 has the highest probability of developing into severe encephalitis,while LGI has the lowest.2.The HDL-C level in serum is an independent risk factor for the prediction of severe AE,which is negatively correlated with the severity of AE.HDL-C≥l.115mmol/L indicates non-severe state of disease.3.The AUC and 95%CI of mRS grade score at admission,HDL-C in serum and predictive model group are 0.674（95%CI 0.579-0.768）,0.728（95%CI 0.638-0.819）and 0.755（95%CI 0.668-0.842）,respectively.Compared with HDL-C alone and mRS grade at admission for predicting severe encephalitis in AE patients,the predictive power of the model established in this study is improved. |
PDF Full Text Request