摘要
目的探究脑电图分级标准在抗N-甲基-D-天门冬氨酸受体(NMDAR)脑炎预后判断中的应用价值。方法回顾性分析2014年1月至2022年9月在山西医科大学第一医院诊断为抗NMDAR脑炎病人50例。根据ECBER、Synek、Young和Lavizzari脑电图分级标准,对病人入院后的首次脑电图进行分级。在病人出院时依据改良Rankin量表(mRS)评分评价预后,mRS评分0~2分为预后良好。比较4种不同脑电图分级标准与预后之间的相关性,选择预后预测效能最高的脑电图分级标准,研究其与病情严重程度、辅助检查及检验结果的相关性。结果ECBER、Synek、Lavizzari这3种脑电图分级标准与病人预后均有明显相关性(P<0.05),脑电图级别越高,预后越差。经预测效能分析,Lavizzari标准的预后预测效能最高[曲线下面积(AUC)值达到0.86,灵敏度为83.33%,特异度为76.32%,P<0.001]。Lavizzari标准的中重度异常脑电图组,在住院时间、监护室住院时间、临床症状数量、并发症数量和病情严重例数及占比分别为[42.00(29.00,53.00)d、16.00(0.00,42.00)d、5.00(4.50,5.50)个、3.00(1.00,3.50)个、13例(68.42%)],轻度异常脑电图组分别为[18.00(12.50,26.00)d、0.00(0.00,1.00)d、3.00(3.00,4.00)个、0.00(0.00,1.50)个、9例(29.03%)],差异有统计学意义(P<0.05),在脑脊液抗体滴度、头颅核磁异常等指标差异无统计学意义(P>0.05)。结论抗NMDAR脑炎病人脑电图异常比例较高。Lavizzari脑电图分级标准对抗NMDAR脑炎病人早期病情评估及预后有较好预测价值,其异常程度与脑脊液抗体滴度、头颅MRI及疾病复发无关。
Objective Exploring the application value of electroencephalogram grading standards in predicting the prognosis of anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis.Methods This was a retrospective analysis of 50 patients who were diagnosed with anti-NMDAR encephalitis between January 2014 and September 2022 at the First Hospital of Shanxi Medical University.The first EEG of patients after admission was graded according to the ECBER,Synek,Young and Lavizzari EEG grading criteria.The prognosis was evaluated based on the modified Rankin scale(mRS)score at the time of patient discharge,with an mRS score of 0-2 indicating a good prognosis.The correlations between the four different EEG grading criteria and the prognosis were compared,and the EEG grading criterion with the highest prognostic efficacy was selected,and its correlation with the severity of the disease,auxiliary examinations and test results was investigated.Results All three EEG grading criteria,ECBER,Synek,and Lavizzari,were significantly correlated with patient prognosis(P<0.05),and the higher the EEG grade,the worse the prognosis.After predictive efficacy analysis,the Lavizzari criterion had the highest prognostic predictive efficacy[area under the curve(AUC)value of 0.86,sensitivity of 83.33%,specificity of 76.32%,P<0.001].The Lavizzari criteria for the moderately severe abnormal EEG group were[42.00(29.00,53.00)d,16.00(0.00,42.00)d,5.00(4.50,5.50),3.00(1.00.3.50),13 patients(68.42%)],and[18.00(12.50,26.00)d,0.00(0.00,1.00)d,3.00(3.00,4.00),0.00(0.00,1.50),9 patients(29.03%)]in the mildly abnormal EEG group,respectively,and the difference was statistically significant(P<0.05).The difference in cerebrospinal fluid antibody titer,cranial nuclear magnetic abnormalities and other indicators was not statistically significant(P>0.05).Conclusion The proportion of patients with anti-NMDAR encephalitis with EEG abnormalities was high,and the Lavizzari EEG grading criteria had good predictive value for the early assessment of the disease and prognosis of patients with anti-NMDAR encephalitis;moreover,the degree of abnormality was not related to the cerebrospinal fluid antibody titer,cranial MRI,or disease recurrence.
作者
李娜
范田华
张森
马联胜
LI Na;FAN Tianhua;ZHANG Sen;MA Liansheng(The First Clinical Medical College,Shanxi Medical University,Taiyuan,Shanxi 030000,China;Department of Neurology,First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030000,China)
出处
《安徽医药》
CAS
2024年第9期1751-1755,I0002,共6页
Anhui Medical and Pharmaceutical Journal
