PDF(Pubmed)
Abstract：
UNASSIGNED: Disturbance of consciousness is common in patients with severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. However, little is known about it. This study aimed to analyze the clinical manifestations and prognostic factors of anti-NMDAR encephalitis with disturbance of consciousness.
UNASSIGNED: In this retrospective study, the clinical features, treatment results, and long-term outcomes of anti-NMDAR encephalitis patients with disturbance of consciousness were analyzed, and multivariate logistic regression was used to analyze the factors affecting their prognosis.
UNASSIGNED: In the group with disturbance of consciousness, the incidences of seizures, involuntary movements, pulmonary infection, mechanical ventilation, intensive care unit (ICU) admission, neutrophil-lymphocyte ratio (NLR), abnormal cerebrospinal fluid index, plasma exchange, and immunosuppressive therapy were higher than those in the group without disturbance of consciousness (all P<0.05). During the follow-up period (median: 36 months, range: 12-78 months), the modified Rankin scale (mRS) score, the maximum mRS score during hospitalization, the mRS score at discharge, and the mRS score at 12 months after discharge were higher in the disturbance of consciousness group (all P < 0.001). However, there was no significant difference in long-term outcomes and recurrence between the two groups. Multivariate logistic regression analysis showed that mechanical ventilation, elevated IgG index, and delayed immunotherapy were independent risk factors for poor outcomes in patients with anti-NMDAR encephalitis with disturbance of consciousness at 12 months (odds ratio: 22.591, 39.868, 1.195). The receiver operating characteristics (ROC) curve analysis showed that the area under the curve (AUC) of mechanical ventilation, elevated IgG index, and delayed immunotherapy was 0.971 (95% CI=0.934-1.000, P<0.001).
UNASSIGNED: Mechanical ventilation, elevated IgG index, and delayed immunotherapy may be the influencing factors of poor prognosis of anti-NMDAR encephalitis patients with disturbance of consciousness. Although their condition is relatively serious, most patients with anti-NMDAR encephalitis with disturbance of consciousness will achieve favorable long-term outcomes after long-term treatment.
UNASSIGNED: In this retrospective study, the clinical features, treatment results, and long-term outcomes of anti-NMDAR encephalitis patients with disturbance of consciousness were analyzed, and multivariate logistic regression was used to analyze the factors affecting their prognosis.
UNASSIGNED: In the group with disturbance of consciousness, the incidences of seizures, involuntary movements, pulmonary infection, mechanical ventilation, intensive care unit (ICU) admission, neutrophil-lymphocyte ratio (NLR), abnormal cerebrospinal fluid index, plasma exchange, and immunosuppressive therapy were higher than those in the group without disturbance of consciousness (all P<0.05). During the follow-up period (median: 36 months, range: 12-78 months), the modified Rankin scale (mRS) score, the maximum mRS score during hospitalization, the mRS score at discharge, and the mRS score at 12 months after discharge were higher in the disturbance of consciousness group (all P < 0.001). However, there was no significant difference in long-term outcomes and recurrence between the two groups. Multivariate logistic regression analysis showed that mechanical ventilation, elevated IgG index, and delayed immunotherapy were independent risk factors for poor outcomes in patients with anti-NMDAR encephalitis with disturbance of consciousness at 12 months (odds ratio: 22.591, 39.868, 1.195). The receiver operating characteristics (ROC) curve analysis showed that the area under the curve (AUC) of mechanical ventilation, elevated IgG index, and delayed immunotherapy was 0.971 (95% CI=0.934-1.000, P<0.001).
UNASSIGNED: Mechanical ventilation, elevated IgG index, and delayed immunotherapy may be the influencing factors of poor prognosis of anti-NMDAR encephalitis patients with disturbance of consciousness. Although their condition is relatively serious, most patients with anti-NMDAR encephalitis with disturbance of consciousness will achieve favorable long-term outcomes after long-term treatment.
摘要：
■意识障碍在患有严重抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎的患者中很常见。然而,对此知之甚少。本研究旨在分析抗NMDAR脑炎合并意识障碍的临床表现及预后因素。
■在这项回顾性研究中，临床特征，治疗结果,并分析抗NMDAR脑炎患者意识障碍的远期疗效,采用多因素logistic回归分析影响其预后的因素。
■在意识障碍的群体中，癫痫发作的发生率，非自愿运动，肺部感染,机械通气,重症监护病房(ICU)入院,中性粒细胞-淋巴细胞比率（NLR），脑脊液指数异常,血浆置换,免疫抑制剂治疗组均高于无意识障碍组(均P<0.05)。在随访期间（中位数：36个月，范围：12-78个月），改良Rankin量表（MRS）评分，住院期间的最大mRS评分，出院时的mRS评分，意识障碍组出院后12个月mRS评分较高(均P<0.001)。然而,两组在长期结局和复发方面无显著差异.多因素logistic回归分析显示,机械通气,IgG指数升高，和延迟免疫治疗是12个月时存在意识障碍的抗NMDAR脑炎患者预后不良的独立危险因素(比值比:22.591,39.868,1.195).受试者工作特征(ROC)曲线分析显示,机械通气的曲线下面积(AUC),IgG指数升高，延迟免疫治疗为0.971(95%CI=0.934~1.000,P<0.001)。
■机械通气,IgG指数升高，延迟免疫治疗可能是抗NMDAR脑炎患者意识障碍预后不良的影响因素。虽然他们的病情比较严重,大多数有意识障碍的抗NMDAR脑炎患者在长期治疗后将获得良好的长期结局.
■在这项回顾性研究中，临床特征，治疗结果,并分析抗NMDAR脑炎患者意识障碍的远期疗效,采用多因素logistic回归分析影响其预后的因素。
■在意识障碍的群体中，癫痫发作的发生率，非自愿运动，肺部感染,机械通气,重症监护病房(ICU)入院,中性粒细胞-淋巴细胞比率（NLR），脑脊液指数异常,血浆置换,免疫抑制剂治疗组均高于无意识障碍组(均P<0.05)。在随访期间（中位数：36个月，范围：12-78个月），改良Rankin量表（MRS）评分，住院期间的最大mRS评分，出院时的mRS评分，意识障碍组出院后12个月mRS评分较高(均P<0.001)。然而,两组在长期结局和复发方面无显著差异.多因素logistic回归分析显示,机械通气,IgG指数升高，和延迟免疫治疗是12个月时存在意识障碍的抗NMDAR脑炎患者预后不良的独立危险因素(比值比:22.591,39.868,1.195).受试者工作特征(ROC)曲线分析显示,机械通气的曲线下面积(AUC),IgG指数升高，延迟免疫治疗为0.971(95%CI=0.934~1.000,P<0.001)。
■机械通气,IgG指数升高，延迟免疫治疗可能是抗NMDAR脑炎患者意识障碍预后不良的影响因素。虽然他们的病情比较严重,大多数有意识障碍的抗NMDAR脑炎患者在长期治疗后将获得良好的长期结局.
