伴随性疾病及其对自身免疫性脑炎结果和传染性并发症的影响:一个多中心队列研究
Amelie Bohn1, Klemens Angstwurm2, Christian G Bien3
1Department of Neurology, RWTH Aachen University, Germany.
Neurology(R) neuroimmunology & neuroinflammation
|July 7, 2025
概括
伴随性疾病,特别是精神疾病,显著影响自身免疫性脑炎的结果. 综合护理和对这些因素的认识对于更好的患者管理和预后至关重要.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 临床医学 临床医学
背景情况:
- 伴随性疾病显著影响疾病的进展,但在自身免疫性脑炎 (AE) 中未得到充分研究.
- 在常见的AE变体中,有关并发症的系统数据很少,需要进一步调查.
研究的目的:
- 在患有抗N-甲基-d-酸盐受体 (NMDAR),抗氨酸丰富的质瘤失活-1 (LGI1),抗接触素相关蛋白类-2 (CASPR2) 和抗免疫球蛋白类细胞粘附分子-5 (IgLON5) 的患者中表征并发症.
- 评估并发症对AE患者结果和感染性并发症的发生的影响.
主要方法:
- 一个多中心的,对308名成年AE患者 (2004年6月至2023年7月) 的回顾性队列研究.
- 对先前存在的疾病 (PECs),二次诊断和感染并发症的分析.
- 在12个月的随访后,使用修改的兰金尺度 (mRS) 评估结果.
主要成果:
- 近一半的AE患者患有心血管和代谢/内分泌并发症;三分之一患有神经病,五分之一患有精神病并发症.
- 存在≥3个PEC,特别是心血管和精神病,与不良结果 (mRS>2) 相联系.
- 精神病学PEC独立预测了不利的结果 (OR 4.55). 严重的感染发生在13.6%的患者中,但没有影响结果.
结论:
- 病前精神疾病是不利的AE结果的关键因素,突出了综合跨学科治疗的必要性.
- 其他器官的同时发生的自身免疫常见,需要进行调查.
- 在急性AE期间的严重感染是中度的,不应该阻止免疫治疗,即使在患有并发症的老年患者中也是如此.
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