Research On The Clinical Features And The Changes Of Immunization Levels Of Autoimmune Encephalitis

Objective: Autoimmune encephalitis is a kind of noninfectious and reversible encephalitis which responds to central nervous system antigen.It is characterized by highly disability and fatality rates and its morbidity and dignostic rates are increasing rencently,but the recognition of autoimmune encephalitis.Although T cell,B cell,complement to participate in the pathogenesis is the main viewpoint,its pathogenesis is still unclear.The purpose of this research is to analyse autoimmune encephalitis’ s clinical features,examine the variation of immune parameters to provide evidence for diagnosis,treatment and pathogenesis.Methods: We collected the clinical data of autoimmune encephalitis patients to analyse the clinical features,and then detected the IgG,Ig A,C3,CD4,CD8,CD20 and CD138 data of both autoimmune encephalitis patients and the control group patients to analyse its pathogenesis.Statistics processing was conducted to analyse the IgG,IgA,C3,CD4,CD8,CD20 and CD138 data of before and after the treatment group,then the curative effect was evaluated.Results:1 Clinical features of the autoimmune encephalitis1)Anti-NMDAR antibody positive patients were the most,27 cases（84.375%）,then were the anti-LGI1 antibody positive patients,3 cases（9.375%）,anti-Ma2 and anti-GABABR antibody positive patients were 1 case（3.125%）respectively.1 patient had multiple antibodies including anti-NMDAR,anti-Yo and anti-Ri antibodies positive at the same time.2)The female of anti-NMDAR encephalitis accounted for 33.33%,and the case that less than 18 years old accounted for 40.74%.Anti-LGI1 encephalitis aged from 42 to 64 years old.3)Psychiatric symptoms,seizures,memory decay could appear in four different types of antibodies associated encephalitis.Anti-NMDAR encephalitis was characteristized by mouth,tongue and limbs involuntary movement in motion transition period,3 cases of anti-LGI1 encephalitis appeared the hyponatremia,anti-Ma2 encephalitis appeared lethargy and ataxia.4)In this group,the highest proportion of clinical symptoms was mental disorders（93.45%）,of which 2 cases were misdiagnosed as mental disorders,then was epilepsy,20 cases（64.52%）.Only 11 patients experienced memory deterioration（35.48%）,of which 1 case was less than 18 years old.5)Four different types of antibodies associated encephalitis could involve structure outside the limbic system and the limbic system.The abnormal rate of MRI was 60%,including 6 cases who were found abnormal during reexamination.6)25 cases conducted electroencephalogram examination,21 cases（84%）were abornormal.Nonspecific slow wave was the most common finding in abnormal electroencephalogram performance,and the large delta wave was noted in 1 patient during the rechecking.7)The results of cerebrospinal fluid（CSF）examination were abnormal in 90%（18/20）patients,including 1 case of patient with intracranial pressure > 500mmH₂ O.Lymphocyte reaction was the mainly finding in the cytological examination,and 1 case had a number of activated monocytes.8)The cases of herpes simplex virus,cytomegalovirus,and pneumonia mycoplasma antibody positive were the most,3 cases respectively.Serum thyroid peroxidase antibody was positive in 2 patients,which was equal to the the cases with rubella virus positive.Acid fast stain was positive in 1 case.2 of those patients had a variety of virus positive at the same time.3 cases of 31 patients were examined for ovarian teratoma,and the three patients underwent ovarian teratoma resection.9)9 cases had complete remission,including 7 cases received both high dose corticosteroids and intravenous immunoglobulin protein,2 cases only received intravenous immunoglobulin.1 patient with recurrence was followed up for 1 year or so.2 The statistical results of pre-immunotherapy group and control group1)Compared with the control group,the level of IgG、Ig A、CD20、CD138 increased in the blood of pre-immunotherapy group,the difference was statistically significant（P < 0.05）.2)Compared with the control group,the level of CD4 decreased in the blood of pre-immunotherapy group,the difference was statistically significant（P < 0.05）.3)Compared with the control group,the level of C3、CD8 had no statistically significant difference（P > 0.05）.3 The statistical results of pre-immunotherapy group and post-immunotherapy group1)Compared with the pre-immunotherapy group,the level of IgG、CD8、CD20、CD138 decreased in the blood of post-immunotherapy group,the difference was statistically significant（P < 0.05）.2)Compared with the pre-immunotherapy group,the level of CD4 increased in the blood of post-immunotherapy group,the difference was statistically significant（P < 0.05）.3)Compared with the pre-immunotherapy group,the level of IgA、C3 had no statistically significant difference（P > 0.05）.Conclusion: Anti-NMDAR encephalitis is most commonly and then is anti-LGI1 encephalitis.Although all four types of antibodies have autoimmunity encephalitis’ typical clinical features of psychiatric symptoms,seizures and memory deterioration,they have their own characteristics.Anti-NMDAR encephalitis patients may have orolingual and body dyskinesia and anti-LGI1 encephalitis patients may have symptom of hyponatremia,anti-Ma2 encephalitis patients have symptom of somnolence and ataxia.Brain MRI has dignostic value in the early stage,electroencephalogram has great value to the dignosis but without speciality.Inflammatory change can be seen in cerebrospinal fluid checking.Humoral immunity and cellular immunity are involved in the pathopoiesia process,and both clinical symtom and immune parameters get better after immune treatment.