| Objective: To study the characteristics of autoimmune encephalitis in Wuhan areas and explore the difference between domestic and foreign patients,building a database of autoimmune encephalitis patients in multiple centers.Methods: 175 cases of autoimmune patients which treated by five major regional central hospitals in Wuhan were collected.The results of the auxiliary examination,the treatment plan,recovery of the patient were recorded.Subgroup comparison by different gender,age.Results: From January 2014 to February 2018,among the 175 cases of autoimmune encephalitis treated in 5 hospitals in central China,86(49.1%)were males and 89(50.9%)were females.The rate is gradually increasing,and the diagnosis time is continuously shortened.There were two incidence peaks between 11-20 and 41-50 years old.The majority of female patients were before the age of 30,and males accounted for the vast majority after the age of 40(?2=17.555,P<0.001).The incidence of speech disorders,involuntary movements and physical activity disorders in adolescents was higher than that of adult patients(P=0.000,0.006,0.001),while the proportion of adults with cognitive impairment was higher than that of adolescents(P=0.001).The proportion of females with tumors was slightly higher than that of men(18.0% vs 10.5%,P=0.156).The proportion of adolescents with tumors was lower than that of adults(6.9% vs 19.4%,P=0.020).Of the patients without tumors,37 patients were found to have a clear etiology of infection.Serum antibody titer was higher than cerebrospinal fluid(CSF)antibody(3.18±0.2 vs 2.46 ± 0.1,P<0.001).Diagnostic sensitivity of CSF antibody detection was superior to Serum(93.6% vs 79.5%).There was a linear relationship between CSF antibody titers and the severity of the disease(P<0.001),Antibody testing was performed 7-13 days with the lowest rate of false negatives.Furthermore,five patients had multiple autoimmune encephalitis antibodies,and 20 cases of encephalitis patients had other auto-antibodies.The proportion of adolescents with NMDAR antibody encephalitis is higher,while other types of encephalitis are mainly adults,rare cases of children(?2=15.1,P<0.001).GABABR antibody encephalitis was more prone to epilepsy(P=0.036),and the incidence of cognitive impairment in LGI1 antibody encephalitis was higher(P=0.016).The three types of common encephalitis were significantly different in combined tumors and prognosis(?2=7.059,P=0.029;?2=9.681,P=0.008)Conclusion: NMDAR encephalitis is the most common autoimmune encephalitis in Wuhan area.Infective factors played an important roles in patients without tumor.The value of CSF antibody is greater than that of serum.Different antibody mediated autoimmune encephalitis has its unique clinical characteristics.As the cases in our group are coming from five large regional centers in Wuhan,the study can represent the central China.Objective: To analysis the factors affecting the prognosis of patients with NMDAR encephalitis,than establish prognostic prediction models in order to early judge the prognosis of NMDAR encephalitis patients.Methods: The clinical data of 103 cases with NMDAR antibody encephalitis treated in the multiple hospitals of Wuhan were selected.According to their outcome at discharge,they were divided into a good prognosis group and a poor prognosis group.Identify the independent risk factors affecting the prognosis of NMDAR antibody encephalitis.The prognosis prediction model was established and optimized.Among them,70 patients from January 2014 to January 2017 were selected as derivation cohort,Thirty-three patients since January 2017 had been used as the verification cohort.Results: A total of 103 NMDAR encephalitis cases were enrolled in this study,with 70 as the derivation cohort,by univariate analysis,it was found that age> 60 years old,dysfunction of autonomic nervous system,antibody titer of cerebrospinal fluid,initial m RS score,electrocardiogram abnormality,electroencephalogram,terminal cerebrospinal fluid abnormality,number of complication,pulmonary infection,gastrointestinal bleeding,liver function Incomplete,into the ICU,endotracheal intubation are risk factors that affect the prognosis,and the merger of the tumor is a protective prognostic factor.Then,by multivariate regression analysis,two prognostic prediction models of disease were established.Model-1 included initial m RS score,cerebrospinal fluid abnormalities,the number of complications,and tumor.After optimization,the area under the ROC curve was 0.831.Model-2 contains three indicators of cerebrospinal fluid antibody titer,cerebrospinal fluid abnormalities and autonomic dysfunction.After optimization,the area under the curve is 0.731.The model was validated using a multicenter 33-patient model with model-1sensitivity of 60.0%,specificity of 88.9%,model-2 sensitivity of 80.0% and specificity of77.8%,and the predictive power(AUC)about 80%.Conclusion: By analyzing the clinical symptoms,complications and auxiliary examinations,we established two prognostic prediction models suitable for Chinese people,which could evaluate the prognosis of patients in two weeks.The two models correspond to different scenarios respectively,could meet the actual needs of the majority of physicians.Objective To observe the long-term prognosis of NMDAR antibody encephalitis real world,than explore the best immunotherapy for Chinese people.Methods 72 patients with anti-NMDAR encephalitis who were treated in Wuhan Tongji Hospital from January 2014 to January 2018 were enrolled in a observational study.Patients were regularly follow-up by counseling in outpatient or telephone.Analyzing the risk factors affecting long-term prognosis,at same time,evaluate the relationship between treatment and prognosis by Cox regression.Results among 72 patients with anti-NMDAR encephalitis,38 were males,ranging in age from 14 to 76 years.Eight patients(11.1%)had combined tumor.During hospitalization,3cases were rejected by individuals and their families without any immunotherapy and 24 cases were treated with conservative immunotherapy,mainly low-dose hormones.The majority of patients(66%)used standard first-line immunotherapies,including 45 cases of high-dose steroid,31 cases of intravenous immunoglobulin,9 cases of plasma exchange,and 9 cases of repeated first-line therapy.In second-line treatment,rituximab was used in 2patients,cyclophosphamide in 4,and tacrolimus in 12.During follow-up,5 patients(6.9%)were lost,54 patients(80.6%)recovered well.As time goes on,the improvement rate gradually increased,no matter whatever immunotherapy were used.Immunotherapy has nothing to do with long-term prognosis,but with a certain relationship with the decreased recurrence of the disease and death.Stratified by the disease assessment model,no significant difference in prognosis was observed in low-risk patients regardless of immunotherapy;whereas in high-risk patients,intensive immunotherapy was more effective than standard treatment.Conclusions: Long-term prognosis of anti-NMDAR encephalitis is good.The recovery process showed gradual improvement in the long period.Intensive immunotherapy does not improve the prognosis,however,could reduce the recurrence rate.Personalized immunotherapy according to the prognostic prediction model,could guarantee and improve the long-term outcome with lower medical burden,which has a good prospects. |
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