抗NMDAR脑炎血清抗NMDAR抗体阴性患者临床分析

目的探讨血清抗N-甲基-D-天冬氨酸受体(NMDAR)抗体阴性的抗NMDAR脑炎患者的临床表现特征、治疗及其预后特点。方法收集郑州大学第一附属医院2013-09—2019-12确诊为抗NMDAR脑炎的60例患者,根据其血清中抗NMDAR抗体的情况分为血清抗体阴性组和阳性组,分析2组临床表现特征、辅助检查、治疗及预后情况。结果60例患者中血清抗NMDAR抗体阴性患者16例(26.6%),血清抗NMDAR抗体阴性组发病年龄高于阳性组(P<0.05)。血清抗体阴性组患者主要症状(包括精神行为异常及意识水平下降)发生率分别为9/16(56.2%)vs 41/44(93.2%),P<0.05和4/16(25.0%)vs 26/44(59.1%),P<0.05]、入院改良Rankin量表(mRS)评分2(1,3)vs 3(2,4),P<0.05]及住院时长20.5(10.0,30.8)d vs 35.5(21.3,49.3)d,P<0.05]均低于阳性组。血清抗体阴性组单用一种一线免疫治疗的患者多于阳性组7/16(43.8%)vs 7/44(15.9%),P>0.05],差异无统计学意义,2组患者的复发及预后差异均无统计学意义分别为3/15(20.0%)vs 12/38(31.6%),P>0.05和13/15(86.7%)vs 35/38(92.1%),P>0.05]。结论抗NMDAR脑炎血清抗NMDAR抗体阴性患者发病年龄较大,精神行为异常及意识水平下降的发生率相对较低,临床症状更轻,通过积极的免疫治疗可以达到较好的预后。

Clinical features of serum NMDAR antibodies negative in anti-NMDAR encephalitis

Objective To analyze the clinical characteristics,treatment and prognosis of anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis with serum anti-NMDAR antibodies negative.Methods Sixty patients diagnosed with anti-NMDAR enceph?alitis in the First Affiliated Hospital of Zhengzhou University from September 2013 to December 2019 were adopted in this study.Ac?cording to the presence of anti-NMDAR antibodies in the serum,the patients were categorized into two groups:seronegative group and seropositive group.The clinical features,laboratory test results,imaging results,treatment and prognosis of the two groups were anal?ysed.Results Among the 60 patients,29 were males and 31 were females,the median age of onset was 23.5(16.0,35.8)years old,and serum NMDAR antibodies were negative in 16 patients(26.6%).The onset age of seronegative group was older than that of sero?positive group(P<0.05).Compared with seropositive group,the seronegative group had a lower incidence of symptoms including psy?chosis and decreased level of consciousness(9/16(56.2%)vs 41/44(93.2%),P<0.05 and 4/16(25.0%)vs 26/44(59.1%),P<0.05),modified Rankin Scale(mRS)score on admission(2(1,3)vs 3(2,4),P<0.05)and duration of hospitalization(20.5(10.0,30.8)d vs 35.5(21.3,49.3)d,P<0.05).There were more patients in seronegative group treated with single first-line immunotherapy than in sero?positive group,but the difference was not statistically significant(7/16(43.8%)vs 7/44(15.9%),P>0.05).The case of relapses and clinical outcome were similar between seronegative and seropositive groups(3/15(20.0%)vs 12/38(31.6%),P>0.05 and 13/15(86.7%)vs 35/38(92.1%),P>0.05).Conclusion The patients with serum NMDAR antibodies negative of anti-NMDAR encephali?tis have older onset age,lower incidence of symptoms including psychosis and decreased level of consciousness,and milder neurologic symptoms.A better prognosis can be achieved by active immunotherapy.