重复应用静注人免疫球蛋白对抗NMDAR脑炎认知障碍的疗效观察

doi:10.3877/cma.j.issn.2095-123X.2022.02.004

目的

探讨重复应用静注人免疫球蛋白对抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者认知障碍的疗效。

方法

收集北京朝阳中西医结合急诊抢救中心神经内科自2018年12月至2021年6月诊治的以认知障碍起病的抗NMDAR脑炎患者24例，采用随机数字表法分为对照组和研究组，每组12例。对照组给予注射用甲泼尼龙琥珀酸钠联合静注人免疫球蛋白基础治疗，研究组在相同基础治疗结束2周后，重复应用静注人免疫球蛋白。观察并比较2组患者治疗前后认知障碍改善情况及不良反应发生情况。

结果

研究组治疗后认知功能评分明显高于对照组，差异有统计学意义（P<0.05）。2组患者治疗期间均未出现严重不良反应，且所发生不良反应经对症治疗或治疗结束后均消失。2组患者的不良反应发生率比较，差异无统计学意义（P>0.05）。

结论

重复应用静注人免疫球蛋白能显著改善抗NMDAR脑炎患者的认知障碍，且相对安全。

关键词: 抗NMDAR脑炎, 认知障碍, 免疫球蛋白, 疗效

Objective

To explore the efficacy of repeated intravenous administration of human immunoglobulin on cognitive impairment in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.

Methods

A collection of 24 patients with anti-NMDAR encephalitis with cognitive impairment who were diagnosed and treated at the Neurology Department of Beijing Chaoyang Integrative Medicine Emergency Medical Center from December 2018 to June 2021, were randomly divided into control group and study group, with 12 cases in each group. The control group received injection methylprednisolone sodium succinate combined with intravenous human immunoglobulin basic therapy, and the study group received repeated intravenous injection of human immunoglobulin 2 weeks after the end of the same basic treatment. The improvement of cognitive impairment and the occurrence of adverse reactions were observed and compared between the two groups before and after treatment.

Results

The cognitive function score of the study group was significantly higher than that of the control group after treatment, and the difference was statistically significant (P<0.05). There were no serious adverse reactions during the treatment period in the two groups, and the adverse reactions occurred after symptomatic treatment or disappeared after treatment. There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Conclusion

Repeated application of intravenous human immunoglobulin can significantly improve cognitive impairment in patients with anti-NMDAR encephalitis, and it is relatively safe.

Key words: Anti-N-methyl-D-aspartate receptor encephalitis, Cognitive impairment, Immunoglobulin, Curative effect

表1 2组患者治疗前后MMSE评分比较（分，Mean±SD）

组别	例数	治疗前	治疗后	t值	P值
对照组	12	15.36±4.62	20.14±3.15	4.869	<0.001
研究组	12	15.38±4.65	24.38±3.22	9.201	<0.001
t值		0.018	5.407
P值		0.986	<0.001

表1 2组患者治疗前后MMSE评分比较（分，Mean±SD）

组别	例数	治疗前	治疗后	t值	P值
对照组	12	15.36±4.62	20.14±3.15	4.869	<0.001
研究组	12	15.38±4.65	24.38±3.22	9.201	<0.001
t值		0.018	5.407
P值		0.986	<0.001

[1]	Vogrig A, Joubert B, André-Obadia N, et al. Seizure specificities in patients with antibody-mediated autoimmune encephalitis[J]. Epilepsia, 2019, 60(8): 1508-1525.
[2]	Ren Y, Chen X, He Q, et al. Co-occurrence of anti-N-methyl-D-aspartate receptor encephalitis and anti-myelin oligodendrocyte glycoprotein inflammatory demyelinating diseases: a clinical phenomenon to be taken seriously[J]. Front Neurol, 2019, 10: 1271.
[3]	de Bruijn MAAM, van Sonderen A, van Coevorden-Hameete MH, et al. Evaluation of seizure treatment in anti-LGI1, anti-NMDAR, and anti-GABABR encephalitis[J]. Neurology, 2019, 92(19): e2185-e2196.
[4]	Pavan B, Ameer A, Preetam J, et al. A case report: anti-NMDA receptor encephalitis[J]. J Community Hosp Intern Med Perspect, 2018, 8(3): 158-160.
[5]	Wiseman AC. Immunosuppressive medications[J]. CJASN, 2016, 11(2): 332-343.
[6]	Gelfand EW. Intravenous immune globulin in autoimmune and inflammatory diseases[J]. N Engl J Med, 2012, 367(21): 2015-2025.
[7]	中华医学会神经病学分会.中国自身免疫性脑炎诊治专家共识[J].中华神经科杂志, 2017, 50(2): 91-98.
[8]	Zhang Y, Liu G, Jiang MD, et al. Analysis of electroencephalogram characteristics of anti-NMDA receptor encephalitis patients in China[J]. Clin Neurophysiol, 2017, 128(7): 1227-1233.
[9]	Tanguturi YC, Cundiff AW, Fuchs C. Anti-N-methyl d-aspartate receptor encephalitis and electroconvulsive therapy: literature review and future directions[J]. Child Adolesc Psychiatr Clin N Am, 2019, 28(1): 79-89.
[10]	Armangue T, Spatola M, Vlagea A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis[J]. Lancet Neurol, 2018, 17(9): 760-772.
[11]	Bost C, Chanson E, Picard G, et al. Malignant tumors in autoimmune encephalitis with anti-NMDA receptor antibodies[J]. J Neurol, 2018, 265(10): 2190-2200.
[12]	Mitra AD, Afify A. Ovarian teratoma associated anti-N-methyl-D-aspartate receptor encephalitis: a difficult diagnosis with a favorable prognosis[J]. Autops Case Rep, 2018, 8(2): e2018019.
[13]	Dale RC, Nosadini M. Infection-triggered autoimmunity: the case of herpes simplex virus type 1 and anti-NMDAR antibodies[J]. Neurol Neuroimmunol Neuroinflamm, 2018, 5(4): e471.
[14]	Sharma R, Al-Saleem FH, Puligedda RD, et al. Membrane-bound and soluble forms of an NMDA receptor extracellular domain retain epitopes targeted in auto-immune encephalitis[J]. BMC Biotechnol, 2018, 18(1): 41.
[15]	Dalmau J, Armangué T, Planagumà J, et al. An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models[J]. Lancet Neurol, 2019, 18(11): 1045-1057.
[16]	Royl G, Fokou TJ, Chunder R, et al. Antibodies against neural antigens in patients with acute stroke: joint results of three independent cohort studies[J]. J Neurol, 2019, 266(11): 2772-2779.
[17]	Iacobucci GJ, Popescu GK. Spatial coupling tunes NMDA receptor responses via Ca2+ diffusion[J]. J Neurosci, 2019, 39(45): 8831-8844.
[18]	Broadley J, Seneviratne U, Beech P, et al. Prognosticating autoimmune encephalitis: a systematic review[J]. J Autoimmun, 2019, 96: 24-34.
[19]	Palakkuzhiyil N, Uvais NA, Moideen S, et al. Anti-NMDA-receptor encephalitis presenting with catatonia in a middle aged male[J]. Asian J Psychiatr, 2018, 35: 26-27.
[20]	贾琳琳.免疫球蛋白联合注射用甲泼尼龙琥珀酸钠冲击治疗自身免疫性脑炎患者的临床效果[J].中国药物经济学, 2021, 16(4): 101-103, 107.

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Observation on the efficacy of repeated intravenous administration of human immunoglobulin on cognitive impairment in patients with anti-NMDAR encephalitis

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Observation on the efficacy of repeated intravenous administration of human immunoglobulin on cognitive impairment in patients with anti-NMDAR encephalitis