摘要：

目的: 探究抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者急性期严重程度及短期预后的影响因素。方法: 纳入2020年1月至2023年7月四川大学华西医院收治的60例抗NMDAR脑炎患者，根据急性期改良Rankin量表（mRS）评分分为轻症组（mRS ≤ 3分，25例）和重症组（mRS > 3分，35例），根据我院治疗1个月后mRS评分分为短期预后良好组（mRS ≤ 3分，32例）和短期预后不良组（mRS > 3分，28例），采用单因素和多因素Logistic回归分析筛查抗NMDAR脑炎患者急性期病情严重及短期预后不良的危险因素。结果: 存在意识障碍（OR= 8.975，95%CI：2.048~39.327；P = 0.004）及高中性粒细胞百分比/白蛋白比值（NPAR；OR= 5.004，95%CI：1.138~22.011，P = 0.033）是抗NMDAR脑炎急性期病情严重的危险因素，高血清IgE水平是其急性期病情较轻的保护因素（OR= 0.994，95%CI：0.989~0.999；P = 0.026）；女性（OR= 4.380，95%CI：1.205~15.929；P = 0.025）、存在意识障碍（OR= 5.493，95%CI：1.535~19.657；P = 0.009）及高NPAR（OR= 2.949，95%CI：1.010~8.612；P = 0.048）是抗NMDAR脑炎患者短期预后不良的危险因素。结论: 存在意识障碍、低血清IgE水平及高NPAR是抗NMDAR脑炎患者急性期病情严重的危险因素，女性、存在意识障碍及高NPAR是其短期预后不良的危险因素。NPAR是潜在的评估抗NMDAR脑炎患者急性期严重程度及预测其短期预后的生物学指标。

关键词: 抗N-甲基-D-门冬氨酸受体脑炎, 健康状况指标, 预后, 危险因素, Logistic模型

Abstract:

Objective: To explore the factors influencing the severity of acute phase and short-term prognosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, and search for potential indicators for assessing disease severity and predicting prognosis. Methods: A total of 60 patients with anti-NMDAR encephalitis admitted to West China Hospital, Sichuan University from January 2020 to July 2023 were included. According to the modified Rankin Scale (mRS) during the acute phase, they were divided into mild group (mRS ≤ 3 score, n = 25) and severe group (mRS > 3 score, n = 35), as well as good outcome group (mRS ≤ 3 score, n = 32) and poor outcome group (mRS > 3 score, n = 28) based on the mRS score after one month of treatment at our hospital. Univariate and multivariate Logistic regression analyses were used to determine the risk factors of anti-NMDAR encephalitis with severe condition during the acute phase and poor short-term prognosis. Results: Logistic regression analysis showed consciousness disorder (OR= 8.975, 95%CI: 2.048-39.327; P = 0.004) and high level of neutrophil percentage-to-albumin ratio (NPAR; OR= 5.004, 95%CI: 1.138-22.011, P = 0.033) were the risk factors of anti-NMDAR encephalitis with severe condition during the acute phase, while high level of serum IgE was the protective factor (OR= 0.994, 95%CI: 0.989-0.999; P = 0.026). Female (OR= 4.380, 95%CI: 1.205-15.929; P = 0.025), consciousness disorder (OR= 5.493, 95%CI: 1.535-19.657; P = 0.009) and high level of NPAR (OR= 2.949, 95%CI: 1.010-8.612; P = 0.048) were the risk factors of anti-NMDAR encephalitis with poor short-term prognosis. Conclusions: Consciousness disorder, low serum IgE level and high NPAR are risk factors of anti-NMDAR encephalitis with severe condition during the acute phase, while female, consciousness disorder and high NPAR are risk factors of anti-NMDAR encephalitis with poor short-term prognosis. NPAR is a potential biological indicator for assessing disease severity during the acute phase and predicting short-term prognosis of patients with anti-NMDAR encephalitis.

Key words: Anti N-methyl-D-aspartate receptor encephalitis, Health status indicators, Prognosis, Risk factors, Logistic models

中图分类号: 

• 抗N-甲基-D-门冬氨酸受体脑炎

• 健康状况指标

• 预后

• 危险因素

• Logistic模型

• Anti N-methyl-D-aspartate receptor encephalitis

• Health status indicators

• Prognosis

• Risk factors

• Logistic models