自身免疫性脑炎的预后因素
| 作者: |
1,2梁文娜,
3郭守刚,
2李立芳
1 山东大学临床医学院，济南 250021 2 聊城市第三人民医院神经内科，山东 聊城 252002 3 山东大学附属省立医院神经内科，济南 250021 |
| 通讯: |
郭守刚
Email: 16966608@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.05.017 |
摘要
目的：探讨自身免疫性脑炎(autoimmune encephalitis，AE)认知与意识障碍等因素与预后的关系。方法：纳入2014年12月至2017年12月山东省立医院、聊城市人民医院、聊城市第三人民医院收治的56例AE患者。收集所有患者临床资料并随访1年，按照改良Ranking量表(modified Rankin Scale， mRS)评价患者预后情况，根据分值将患者分为预后良好组(mRS评分0~3)40例，预后不佳组(mRS评分>3)16例。其中意识障碍采用格拉斯哥昏迷(Glasgow Coma Scale，GCS)评分进行评估，采用相关量表[智商(intelligence quotient，IQ)、记忆功能(memor y quotient，MQ)、脑损伤(damage quot ient，DQ)]对患者入院时认知功能进行评估，并对影响患者预后的症状特点进行多因素Logistic回归分析。结果：预后良好组中出现意识障碍、自主神经功能障碍、局灶神经功能障碍等症状的比例明显低于预后不佳组，差异有统计学意义( P<0.05)。两组患者IQ，MQ，DQ差异无统计学意义(P>0.05)，预后不佳组中意识昏迷(GCS评分<9)患者所占比例明显高于预后良好组(P< 0.05)。Logistic多因素回归分析显示：意识障碍、自主神经功能障碍(OR=12.45， OR=7.85，P<0.01)是影响AE预后的独立危险因素。结论：AE临床表现为多种神经症状和精神行为异常，其中认知障碍对其预后影响较小，意识障碍和自主神经功能障碍是影响AE患者预后的独立危险因素。
关键词：
自身免疫性脑炎；认知障碍；意识障碍；预后；危险因素
Prognostic factors of autoimmune encephalitis
CorrespondingAuthor: GUO Shougang Email: 16966608@qq.com
DOI: 10.3978/j.issn.2095-6959.2019.05.017
Abstract
Objective: To explore the relationship between prognosis and cognitive and consciousness disorders in patients with autoimmune encephalitis (AE). Methods: A total of 56 patients with AE in Shandong Provincial Hospital, Liaocheng People’s Hospital, Liaocheng Third People’s Hospital were studied, from December 2014 to December 2017. The clinical data of all patients were collected and followed up for 1 year. The prognosis was evaluated by modified Ranking Scale (mRS). According to the score, patients were divided into a good prognosis group (n=40, mRS score 0–3) and a poor prognosis group (n=16, mRS score >3). Consciousness disorder was assessed by Glasgow Coma Scale (GCS) score, cognitive impairment was assessed by IQ, MQ and DQ scales, and multivariate logistic regression analysis was made on the characteristics of symptoms affecting the prognosis of patients. Results: The proportion of symptoms such as conscious disturbance, autonomic nervous dysfunction and focal nervous dysfunction in the good prognosis group were significantly lower than that in the poor prognosis group (P<0.05). There were no significant difference in IQ, MQ and DQ between the two groups (P>0.05),the proportion of coma patients with bad prognosis (GCS score <9) were significantly higher than that with good prognosis (P<0.05). Logistic multivariate regression analysis showed that consciousness disorder and autonomic nervous dysfunction were independent risk factors affecting the prognosis of AE (OR=12.45, OR=7.85, P<0.01). Conclusion: The clinical manifestations of AE are various neurological symptoms and abnormal mental behavior. Cognitive impairment has little effect on the prognosis of AE. Consciousness disorder and autonomic nervous dysfunction are independent risk factors affecting the prognosis of AE.
Keywords：
autoimmune encephalitis; cognitive impairment; disturbance of consciousness; prognosis; risk factors