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潘晓颖, 陈国华, 宁玉萍, 等. 抗NMDA受体脑炎的脑电图特点及其临床评估价值[J]. 四川大学学报(医学版), 2023, 54(2): 293-297. DOI: 10.12182/20230360502
引用本文: 潘晓颖, 陈国华, 宁玉萍, 等. 抗NMDA受体脑炎的脑电图特点及其临床评估价值[J]. 四川大学学报(医学版), 2023, 54(2): 293-297. DOI: 10.12182/20230360502
PAN Xiao-ying, CHEN Guo-hua, NING Yu-ping, et al. Electroencephalogram Features of Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Their Value for Clinical Assessment[J]. Journal of Sichuan University (Medical Sciences), 2023, 54(2): 293-297. DOI: 10.12182/20230360502
Citation: PAN Xiao-ying, CHEN Guo-hua, NING Yu-ping, et al. Electroencephalogram Features of Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Their Value for Clinical Assessment[J]. Journal of Sichuan University (Medical Sciences), 2023, 54(2): 293-297. DOI: 10.12182/20230360502

抗NMDA受体脑炎的脑电图特点及其临床评估价值

Electroencephalogram Features of Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Their Value for Clinical Assessment

  • 摘要:
      目的  总结分析抗N-甲基-D-天冬氨酸受体脑炎(抗NMDA受体脑炎)患者的脑电图特点,并探索脑电背景慢化分级、δ刷对临床评估的价值。
      方法  纳入52例抗NMDA受体脑炎患者临床资料,包括年龄、性别、起病形式、合并肿瘤情况、辅助检查(脑脊液抗NMDA受体抗体滴度、MRI报告和脑电图结果)、治疗情况和出院随访情况。分析不同临床特征患者的脑电背景异常程度(EEG)、δ刷情况。
      结果  52例患者中7例脑电图正常(14%),45例脑电图异常(87%),包括:轻度异常25例(48%),中度异常 11例(21%),重度异常9例(17%)。6例出现δ刷(12%)。脑电图检查时病情轻组有32例(62%),病情重组有20例(38%)。随访1年后,预后良好组有45例(86%),预后不佳组有7例(14%)。脑电背景异常程度越重、出现δ刷提示病情重、需要ICU治疗、预后不佳的比例增高(P<0.01)。脑电背景异常程度越重,CSF抗体滴度>1∶10的比例越高(P=0.035),脑电背景异常程度越重,启动二线免疫治疗比例越高(P=0.008)。合并肿瘤的患者出现δ刷的比例更高(P=0.012)。首发病例较复发病例出现δ刷的概率更高(P=0.023)。
      结论  脑电慢化程度和δ刷在评估病情、预测预后结果上一致,EEG越慢病情越重、预后越差,出现δ刷提示病情重、预后差。EEG慢化与抗MNDA受体脑炎的免疫状态相关,EEG越慢,免疫异常越重,临床上可动态检测患者的EEG以评估免疫治疗效果,若EEG慢化未改善应及早考虑加强免疫治疗。合并肿瘤的患者出现δ刷的比例更高,因此当出现δ刷时应积极排查肿瘤。

     

    Abstract:
      Objective  To analyze the electroencephalogram (EEG) features of anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) and to study the clinical assessment value of the degree of EEG background slowing and the presence of δ brush.
      Methods  We enrolled 52 patients with anti-NMDARE and collected their clinical data, including age, sex, form of disease onset, status of tumor comorbidity, auxiliary examination findings (cerebrospinal fluid CSF anti-methyl-D-aspartate receptor antibody titers, magnetic resonance imaging MRI reports, and EEG results), treatment status, and follow-up after discharge. The degree of EEG background abnormality and the presence of δ brush in the EEG of patients with different clinical features were analyzed.
      Results  Among the 52 patients, 7 (14%) had normal EEG, and 45 (87%), abnormal EEG, including 25 (48%) with mild abnormalities, 11 (21%) with moderate abnormalities, and 9 (17%) with severe abnormalities. δ brush was seen in 6 (12%) patients. At the time of EEG, 32 (62%) patients were in the mild condition group and 20 (38%) patients were in the severe condition group. After 1 year of follow-up, there were 45 (86%) patients in the good prognosis group and 7 (14%) patients in the poor prognosis group. The exacerbation of EEG background abnormalities and the presence of δ brush were indications for an increase in the proportion of patients who were in severe condition, who needed ICU admission, and who had poor prognosis (P<0.01). The worse the EEG background abnormalities, the higher the proportion of CSF antibody titers>1∶10 (P=0.035), and the higher the proportion of patients initiating second-line immunotherapy (P=0.008). The δ brush was seen a higher proportion in patients with comorbid tumors (P=0.012). The probability of δ brush presence was higher in the first-time diagnosis cases than that in recurrent cases (P=0.023).
      Conclusions  The degree of EEG slowing and the presence of δ brush have shown consistent performance in assessing patients' condition and predicting prognosis. The slower the EEG, the more severe the disease, and the worse the prognosis. The presence of δ brush indicates severe disease and poor prognosis. EEG slowing is correlated with the immune status of patients with anti-NMDARE. The slower the EEG, the more severe the immune abnormalities. In clinical practice, patient EEG should be under dynamic monitoring in order to evaluate the effect of immunotherapy. If EEG slowing is not improved, enhanced immunotherapy should be considered as early as possible. The δ brush is seen at a higher proportion in patients with comorbid tumors. Therefore, active efforts should be made to screen for tumors when δ brush is present.

     

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