自身免疫性脑炎并发血脑屏障损伤的发生情况及其危险因素分析

Incidence and risk factors of autoimmune encephalitis complicated with blood-brain barrier injury

摘要:

目的 分析影响自身免疫性脑炎患者并发血脑屏障损伤情况及导致其并发血脑屏障损伤的危险因素。方法 回顾性分析2018年5月至2023年5月在焦作市人民医院确诊的90例自身免疫性脑炎患者，根据患者是否并发血脑屏障损伤将其分为并发血脑屏障损伤组（n=41）和非并发血脑屏障损伤组（n=49）。收集两组患者的临床资料，对其相关资料进行单因素分析和Logistic多因素回归分析影响自身免疫性脑炎患者并发血脑屏障损伤的危险因素。结果 并发血脑屏障损伤组患者精神异常、反应迟钝发生率、脑电图δ刷异常和头颅磁共振异常较非并发血脑屏障损伤组高（P<0.05）。并发血脑屏障损伤组患者脑脊液中蛋白水平增高、白细胞（WBC）计数增高、免疫球蛋白G（IgG）增高、24 h鞘内IgG合成率增高高于非并发血脑屏障损伤组（P<0.05）。Logistic回归性分析表明，自身免疫性脑炎患者有精神异常、脑电图δ刷异常、蛋白水平增高>450 mg/L和IgG增高>4 mg/L是并发血脑屏障损伤的独立危险因素（P<0.05）。结论 自身免疫性脑炎患者是否并发血脑屏障损伤和是否有精神迟钝症状、脑电图δ刷异常、蛋白水平增高>450 mg/L和IgG增高>4 mg/L有关，可以根据自身免疫性脑炎患者具体病情在治疗过程中优化治疗方案。

Abstract:

Objective To analyze blood-brain barrier injury and its risk factors in patients with autoimmune encephalitis.Methods A total of 90 patients with autoimmune encephalitis confirmed in the hospital were retrospectively analyzed between May 2018 and May 2023. According to presence or absence of blood-brain barrier injury, they were divided into injury group (n=41) and non-injury group (n=49). The clinical data in the two groups were collected. The risk factors of blood-brain barrier injury were analyzed by univariate analysis and logistic multivariate regression analysis.Results The incidence of mental abnormality, reaction retardation, EEG δ brush abnormality and skull magnetic resonance abnormality in injury group was higher than that in non-injury group (P<0.05). There were significant differences in the increase of protein level in cerebrospinal fluid, white blood cell (WBC) count, immunoglobulin G (IgG) and 24-hour intramural IgG synthesis rate between the two groups (P<0.05). Logistic regression analysis showed that mental retardation, EEG δ brush abnormality, protein increase >450 mg/L and IgG increase >4 mg/L were independent risk factors of blood-brain barrier injury (P<0.05).Conclusion The occurrence of blood-brain barrier injury is related to mental retardation, EEG δ brush abnormality, protein increase >450 mg/L and IgG increase >4 mg/L in patients with autoimmune encephalitis. The therapeutic regimens can be optimized according to the specific conditions of patients with autoimmune encephalitis.