文章摘要

血清白蛋白水平对儿童自身免疫性脑炎预后的预测价值

作者: 1王惠萍, 1王左华, 1龚燕, 1王春霞, 2彭俊
1 昆明市儿童医院神经内科,昆明 650228
2 云南省第一人民医院教育科研处,昆明 650032
通讯: 彭俊 Email: 389647518@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.12.021
基金: 云南省王艺专家工作站(2019IC050);昆明市科技保障民生发展计划项目(2019-1-S-25318000001445);昆明市卫生科技人才培养项目暨“十百千”工程省内知名专家基金资助项目[2020-SW(省)-28];昆明市卫生健康委卫生科研课题(2020-06-04-114)。

摘要

目的:分析血清白蛋白(albumin,ALB)水平对儿童自身免疫性脑炎(autoimmune encephalitis,AE)预后的预测价值。方法:选取78例AE患儿作为研究对象,根据其入院血清ALB水平分为研究组(血清ALB水平<40 g/L,36例)和对照组(血清ALB水平≥40 g/L,42例),对两组患儿的一般资料、辅助检查指标、临床症状进行对比分析并对其免疫治疗3个月时的预后进行短期随访。结果:研究组和对照组分别有2例和3例患儿失访,两组最终分别纳入34例和39例患儿,两组患儿一般资料的差异均无统计学意义(P>0.05)。研究组患儿中改良Rankin量表(modified Rankin scale,mRs)评分≥4的比例高于对照组,且抗体类型以抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)抗体为主,临床分型以抗NMDAR脑炎为主,差异有统计学意义(P<0.05)。两组患儿的其他辅助检查指标的差异均无统计学意义(P>0.05)。研究组患儿出现意识障碍的比例高于对照组,差异有统计学意义(P<0.05),出现其他症状的比例差异均无统计学意义(P>0.05)。在随访期末,有48例患儿预后良好,有25例患儿预后不良,预后不良患儿的入院时血清ALB降低比例、mRs评分≥4比例、磁共振成像(magnetic resonance imaging,MRI)异常比例、脑电图(electroencephalogram,EEG)异常比例均高于预后良好患儿,差异均有统计学意义(P<0.05)。Logistic多元回归分析结果显示,AE患儿的不良预后与ALB降低、mRs评分≥4具有相关性(P<0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线分析结果显示,入院时血清ALB降低和mRs评分≥4预测AE患儿预后不良的AUC ROC(area under the curve of ROC)分别为0.785和0.684(P<0.05),其中,血清ALB降低的AUC ROC较高,灵敏度和特异度分别为0.84和0.729。结论:免疫治疗前血清ALB水平较低的AE患儿的临床症状较重、易出现意识障碍、抗NMDAR抗体多见,血清ALB水平的降低与患儿短期预后不良相关,可作为预测儿童AE短期预后的辅助指标。
关键词: 白蛋白;儿童;自身免疫性脑炎;预后;受试者工作特征曲线

Value of serum albumin level in prediction of the prognosis in children with autoimmune encephalitis

Authors: 1WANG Huiping, 1WANG Zuohua, 1GONG Yan, 1WANG Chunxia, 2PENG Jun
1 Department of Neurology, Children’s Hospital of Kunming City, Kunming 650228
2 Division of Scientific Research and Education, First People’s Hospital of Yunnan Province, Kunming 650032, China

CorrespondingAuthor: PENG Jun Email: 389647518@qq.com

Foundation: This work was supported by the Yunnan Wangyi Expert Workstation (2019IC050), Kunming Science and Technology Guarantee People’s Livelihood Development Plan Project (2019-1-S-25318000001445), Kunming Health Science and Technology Personnel Training Project and “Ten Thousand” Project Funded by Provincial Famous Experts Fund [2020-SW(Province)-28], Health Research Project of Kunming Health Commission (2020-06-04-114), China.

Abstract

Objective: To analyze the predictive value of serum albumin (ALB) level for the prognosis of children with autoimmune encephalitis (AE). Methods: Seventy-eight children with AE were divided into the study group (36 cases, with serum ALB level <40 g/L) and the control group (42 cases, with serum ALB level ≥40 g/L) according to the level of serum ALB in admission. The general data, the auxiliary examination indexes, and the clinical symptoms between the patients in the two groups were compared and analyzed, and the short-term prognosis after 3 months of immunotherapy as followed up. Results: In the study group and the control group, there were 2 and 3 children lost their visits, so 34 and 39 children were included into the two groups, respectively. There was no significant difference in general data information between the two groups (P>0.05). The proportion of modified Rankin scale (mRS) score ≥4 of the children in the study group was higher than that in the control group, and the antibody type was mainly anti N-methyl-D-aspartic acid receptor (NMDAR) antibody, the clinical classification is mainly anti-NMDAR encephalitis, the differences were statistically significant (P<0.05), while the differences of other auxiliary examination indexes between the two groups were not statistically significant (P>0.05). The proportion of children with consciousness disorder in the study group was higher than that in the control group, the difference was statistically significant (P<0.05), while the proportions of children with other symptoms were not statistically significant (P>0.05). At the end of the follow-up period, 48 children had a good prognosis, 25 children had a bad prognosis. The proportion of ALB reduction, the proportion of mRs score ≥4, the abnormal magnetic resonance imaging (MRI) ratio, the proportion of abnormal electroencephalogram (EEG) in the children with poor prognosis were higher than those in the patients with good prognosis, the differences were statistically significant (P<0.05). Logistic multiple regression analysis showed that the poor prognosis of AE children was correlated with decreased ALB and mRs score ≥4 (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that area under the curve of ROC (AUC ROC) of ALB reduction and mRs score ≥4 to predict the poor prognosis of AE children were 0.785 and 0.684 respectively (P<0.05), among which, AUC ROC of ALB reduction was higher, the sensitivity and specificity were 0.84 and 0.729 respectively. Conclusion: AE children with lower serum ALB level before immunotherapy show more serious clinical symptoms, more consciousness disorder, and more common anti NMDAR antibody. The decrease of serum ALB level is related to the poor short-term prognosis of children, which can be used as an auxiliary index to predict the short-term prognosis of children with AE.
Keywords: albumin; children; autoimmune encephalitis; prognosis; receiver operating characteristic curve