摘要
目的 通过分析成人危重症自身免疫性脑炎患者的临床特征及预后,探讨其预后不良临床结局的预测因素.方法 回顾性收集2015年1月至2023年12月在中南大学湘雅二医院神经内科重症监护室(ICU)住院、诊断为"确诊的"或"可能的"自身免疫性脑炎患者的临床资料,并追踪随访患者发病3、6、12个月的神经功能情况,以12个月时改良Rankin量表(mRS)作为临床预后的评价指标,进一步分析其临床特征、辅助检查和预后的关系.结果 本中心成人危重症自身免疫性脑炎患者发病12个月生存率是90.7％(117/129),发病6个月预后不良率是28.7％(37/129).单因素logistic回归分析发现发病年龄(P＜0.01)、合并肿瘤(P＜0.01)、机械通气(P＜0.01)、入ICU时格拉斯哥昏迷评分(GCS)(P＜0.01)、APACHE Ⅱ评分(P＜0.01)、脑脊液葡萄糖(P＜0.01)、脑脊液蛋白量(P=0.02)、脑电图的癫痫波(P=0.03)、糖皮质激素的使用(P=0.04)和启动静脉注射免疫球蛋白(IVIG)距发病的时间间隔(P=0.04)与预后相关.多因素logistic回归分析结果显示机械通气(P=0.01,AUC=0.72)、APACHE Ⅱ评分(P=0.04,AUC=0.68)、脑脊液蛋白量(P=0.04,AUC=0.65)、启动IVIG距发病的时间间隔(P=0.02,AUC=0.64)是成人危重症自身免疫性脑炎预后的独立预测因子.联合应用这四项指标建立的成人危重症自身免疫性脑炎预后预测模型具有更高的AUC(0.85).结论 机械通气、APACHE Ⅱ评分、脑脊液蛋白量和启动IVIG距发病的时间间隔是成人危重症自身免疫性脑炎预后不良临床结局的预测因素;联合应用这四项指标建立的成人危重症自身免疫性脑炎预后预测模型可早期识别预后不良的患者,有利于更早的综合管理和干预治疗,以改善患者预后.
Abstract
Objective To explore the predictive factors for adverse clinical outcomes in critically ill adult patients with autoimmune encephalitis by analyzing their clinical characteristics and prognosis.Methods Clinical data of patients diagnosed with"confirmed"or"possible"autoimmune encephalitis who were hospitalized in the intensive care unit(ICU)of the Department of Neurology at the Second Xiangya Hospital of Central South University from January 2015 to December 2023 were retrospectively collected.The neurological function of patients at 3,6,and 12 months of onset was followed up,and the modified Rankin Scale(mRS)at 12 months was used as an evaluation index for clinical prognosis;Further analysis was conducted on the relationship between clinical features,auxiliary examinations,and prognosis.Results The 12-month survival rate of critically ill adult patients with autoimmune encephalitis in our center was 90.7％(117/129),and the 6-month poor prognosis rate was 28.7％(37/129).Univariate logistic regression analysis found that age of onset(P＜0.01),presence of tumors(P＜0.01),mechanical ventilation(P＜0.01),Glasgow Coma Scale(GCS)at ICU admission(P＜0.01),Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score(P＜0.01),cerebrospinal fluid glucose(P＜0.01),cerebrospinal fluid protein level(P=0.02),epileptic waves in electroencephalography(EEG)(P=0.03),use of glucocorticoids(P=0.04),and time interval between initiation of intravenous immunoglobulin(IVIG)and onset(P=0.04)were associated with prognosis.The results of multiple logistic regression analysis showed that mechanical ventilation[P=0.01,area under the curve(AUC)=0.72)],APACHEⅡ score(P=0.04,AUC=0.68),cerebrospinal fluid protein content(P=0.04,AUC=0.65),and the time interval between initiation of IVIG and onset(P=0.02,AUC=0.64)were independent predictive factors for the prognosis of adult critical autoimmune encephalitis.The prognostic prediction model for adult critical autoimmune encephalitis established by combining these four indicators has a higher AUC(0.85).Conclusions Mechanical ventilation,APACHE Ⅱ score,cerebrospinal fluid protein level,and the time interval between initiation of IVIG and onset are predictive factors for poor clinical outcomes in critically ill autoimmune encephalitis in adults;The prognostic prediction model for adult critical autoimmune encephalitis established by combining these four indicators can identify patients with poor prognosis early,which is beneficial for early comprehensive management and intervention treatment to improve patient prognosis.
维普
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