摘要：

目的: 总结新疆地区不同抗体类型感染相关性自身免疫性脑炎的临床特征，并探讨相关实验室指标的诊断价值。方法: 共纳入2018年1月至2023年10月新疆维吾尔自治区人民医院诊断与治疗的47例感染相关性自身免疫性脑炎患者，包括抗富亮氨酸胶质瘤失活蛋白1（LGI1）抗体相关脑炎18例（38.30%）、抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎16例（34.04%）、抗髓鞘少突胶质细胞糖蛋白（MOG）抗体相关脑炎8例（17.02%）、抗γ-氨基丁酸B型受体（GABA_BR）脑炎5例（10.64%），采集社会人口学资料、临床表现、实验室及其他辅助检查结果，绘制受试者工作特征（ROC）曲线以评价相关实验室指标对不同抗体类型感染相关性自身免疫性脑炎的诊断价值。结果: 抗LGI1抗体相关脑炎、抗NMDAR脑炎、抗MOG抗体相关脑炎、抗GABA_BR脑炎患者发病年龄（χ²=9.500，P=0.023），肌无力（χ²=9.967，P=0.019）、视力下降（χ²=9.967，P=0.019）和癫痫发作（χ²=8.046，P=0.045），脑脊液白细胞计数（χ²=15.237，P=0.002）和氯化物（F=4.156，P=0.011）差异具有统计学意义，其中，抗LGI1抗体相关脑炎患者发病年龄晚于抗NMDAR脑炎（Z=-2.384，P=0.017）和抗MOG抗体相关脑炎（Z=-2.420，P=0.016）患者，抗NMDAR脑炎患者脑脊液白细胞计数高于抗LGI1抗体相关脑炎（Z=-3.307，P=0.001）和抗MOG抗体相关脑炎（Z=-2.835，P=0.005）患者，抗NMDAR脑炎（t=3.159，P=0.007）和抗GABA_BR脑炎（t=-4.592，P=0.007）患者脑脊液氯化物高于抗LGI1抗体相关脑炎患者。ROC曲线显示，发病年龄诊断抗LGI1抗体相关脑炎的曲线下面积为0.722（95% CI：0.569~0.875，P=0.012），灵敏度为0.556、特异度为0.821，截断值为54.50岁。脑脊液白细胞计数诊断抗LGI1抗体相关脑炎的曲线下面积为0.706（95% CI：0.558~0.855，P=0.019），灵敏度为0.889、特异度为0.571，截断值为4.50 × 10⁶/L；诊断抗NMDAR脑炎的曲线下面积为0.790（95% CI：0.643~0.937，P=0.002），灵敏度为0.600、特异度为0.967，截断值为13.50 × 10⁶/L。脑脊液氯化物诊断抗LGI1抗体相关脑炎的曲线下面积为0.748（95% CI：0.598~0.898，P=0.005），灵敏度为0.722、特异度为0.714，截断值为122.70 mmol/L。结论: 新疆地区不同抗体类型感染相关性自身免疫性脑炎具有特定的临床特征，发病年龄、脑脊液白细胞计数和氯化物对抗LGI1抗体相关脑炎具有良好的诊断价值，脑脊液白细胞计数对抗NMDAR脑炎具有良好的诊断价值。

关键词: 脑炎, 神经系统自身免疫疾病, ROC曲线, 新疆维吾尔自治区

Abstract:

Objective: To summarize the clinical features of infection-associated autoimmune encephalitis (IAE) with different antibodies in Xinjiang region, and to explore the diagnostic value of relevant laboratory indicators for IAE. Methods: A total of 47 patients with IAE diagnosed and treated in People's Hospital of Xinjiang Uiger Autonomous Region from January 2018 to October 2023 were enrolled, including 18 cases (38.30%) of anti-leucine-rich glioma-inactivated 1 (LGI1) antibody-associated encephalitis, 16 cases (34.04%) of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, 8 cases (17.02%) of anti-myelin oligodendrocyte glycoprotein (MOG) antibody- associated encephalitis, and 5 cases (10.64%) of anti-γ-aminobutyric acid receptor type B (GABA_BR) encephalitis. Social demographic data, clinical manifestations, laboratory and other examinations were collected, and receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of relevant laboratory indicators for IAE. Results: The age of onset (χ² = 9.500, P = 0.023), myasthenia (χ² = 9.967, P = 0.019), vision loss (χ² = 9.967, P = 0.019) and seizures (χ² = 8.046, P = 0.045), cerebrospinal fluid (CSF) white blood cell count (χ² = 15.237, P = 0.002) and chloride (F = 4.156, P = 0.011) in patients with anti-LGI1 antibody-associated encephalitis, anti-NMDAR encephalitis, anti-MOG antibody-associated encephalitis and anti-GABA BR encephalitis were statistically significant. The age of onset in patients with anti-LGI1 antibody- associated encephalitis was larger than that in patients with anti-NMDAR encephalitis (Z =-2.384, P = 0.017) and anti- MOG antibody-associated encephalitis (Z =-2.420, P = 0.016). The CSF white blood cell count in patients with anti-NMDAR encephalitis was higher than that in patients with anti-LGI1 antibody-associated encephalitis (Z =-3.307, P = 0.001) and anti-MOG antibody-associated encephalitis (Z =-2.835, P = 0.005). CSF chloride was higher in patients with anti-NMDAR encephalitis (t = 3.159, P = 0.007) and anti-GABA_BR encephalitis (t =-4.592, P = 0.007) than in patients with anti-LGI1 antibody-associated encephalitis. ROC curve showed that the area under the curve (AUC) of age of onset for diagnosis of anti-LGI1 antibody-associated encephalitis was 0.722 (95%CI: 0.569-0.875, P = 0.012), the sensitivity was 0.556, the specificity was 0.821, and the cut-off value was 54.50 years old. The AUC of CSF white blood cell count in the diagnosis of anti-LGI1 antibody-associated encephalitis was 0.706 (95%CI: 0.558-0.855, P = 0.019), the sensitivity was 0.889, the specificity was 0.571, and the cut- off value was 4.50 × 10⁶/L. The AUC in the diagnosis of anti-NMDAR encephalitis was 0.790 (95%CI: 0.643-0.937, P = 0.002), the sensitivity was 0.600, the specificity was 0.967, and the cut-off value was 13.50 × 10⁶/L. The AUC of CSF chloride for the diagnosis of anti-LGI1 antibody-associated encephalitis was 0.748 (95%CI: 0.598-0.898, P = 0.005), with a sensitivity of 0.722 and a specificity of 0.714, and a cut- off value of 122.70 mmol/L. Conclusions: IAE with different antibodies in Xinjiang region has specific clinical features. Age of onset, CSF white blood cell count and chloride have important value in the diagnosis of anti-LGI1 antibody-associated encephalitis, and CSF white blood cell count has important value in the diagnosis of anti-NMDAR encephalitis.

Key words: Encephalitis, Autoimmune diseases of the nervous system, ROC curve, Xinjiang