Annals of Clinical and Translational Neurology:小脑体积减少可能反映NMDAR脑炎疾病负担和进展程度

2022-06-26 影像小生 MedSci原创

小脑体积减少可能反映NMDAR脑炎疾病负担和进展程度,并与多个功能领域的不良结局相关。

N-甲基D-天冬氨酸受体抗体(NMDAR)脑炎是由IgG自身抗体与NMDAR的NR1亚基结合引起的,这导致NMDAR从突触表面内化。通过联合免疫治疗和相关畸胎瘤的切除,大约75 - 80%的患者获得了良好的长期预后。然而,长期预后存在很大的异质性,相当多的患者仍有显著的神经系统后遗症。因此,阐明这种可逆性疾病中与永久性神经功能缺损和不良长期预后相关的因素,可能是优化治疗方案和改善NMDAR脑炎预后的关键。

最近Annals of Clinical and Translational Neurology刊发首尔国立大学医院神经内Woo-Jin Lee等的研究文章,探讨NMDAR脑炎脑体积改变的纵向模式、决定因素及临床意义。

该研究团队从一个长期的NMDAR脑炎队列临床数据库中获取基线临床概况、治疗概况和结果,使用自身免疫性脑炎临床评估量表(CASE)和改良Rankin量表(mRS)进行测量。在序列MRI中,从基线评估开始测量不同脑区归一化体积的变化。在每个MRI评估时间点,也评估累积疾病负担(CASE评分月)和累积癫痫持续状态持续时间。

36例患者获得随访资料,随访时间为28.5个月(12-63个月)。

研究发现

1.末次MRI与基线体积比为小脑最低(94.4±5.7%,p < 0.001)。

2.一旦疾病进展,小脑体积减少遵循一个进行性过程,直到发病2年。小脑体积缩小程度与mRS、CASE总分 (all, p < 0.001),以及在记忆、语言和精神问题、步态不稳定/共济失调和虚弱等领域的CASE得分(all, p < 0.01) 呈正相关关系。

脑区连续体积减小的趋势线,患者2年以上自身免疫性脑炎(CASE)临床评估量表评分的变化,以及累积疾病负担与脑体积减小幅度之间的相关性

脑区连续体积变化。

3.在线性混合模型分析中,小脑体积减少的程度与长达2年的累积疾病负担 (p < 0.001)和癫痫持续状态持续时间(p < 0.001),畸胎瘤延迟切除≥1个月(p = 0.006) 相关。

在NMDAR脑炎中,一旦进展,小脑体积减小是进行性的。小脑体积减少可能反映疾病负担和进展程度,并与多个功能领域的不良结局相关。

原文出处

Disease progression and brain atrophy in NMDAR encephalitis: Associated factor & clinical implication

https://onlinelibrary.wiley.com/doi/full/10.1002/acn3.51604

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status=1, ipAttribution=)]
  4. 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  5. 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replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70730, encryptionId=1a1de07305e, topicName=疾病负担)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/B389FA68ECBF51BE2FE14093CF61F6AE/100, createdBy=eb8e2500096, createdName=夏天与十三菇凉, createdTime=Sat Jun 25 07:35:13 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343623, encodeId=37a6134362369, content=<a href='/topic/show?id=928a849314c' target=_blank style='color:#2F92EE;'>#脑炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84931, encryptionId=928a849314c, topicName=脑炎)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Sat Jun 25 07:35:13 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
    2022-12-28 fengxx
  6. 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replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70730, encryptionId=1a1de07305e, topicName=疾病负担)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/B389FA68ECBF51BE2FE14093CF61F6AE/100, createdBy=eb8e2500096, createdName=夏天与十三菇凉, createdTime=Sat Jun 25 07:35:13 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343623, encodeId=37a6134362369, content=<a href='/topic/show?id=928a849314c' target=_blank style='color:#2F92EE;'>#脑炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84931, encryptionId=928a849314c, topicName=脑炎)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Sat Jun 25 07:35:13 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
    2023-04-30 柳叶一刀
  7. 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createdTime=Wed Dec 28 20:35:13 CST 2022, time=2022-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1657652, encodeId=918f165e65214, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Sun Apr 30 17:35:13 CST 2023, time=2023-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001839, encodeId=08222001839b8, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sat Jun 03 18:35:13 CST 2023, time=2023-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2030220, encodeId=62b12030220af, content=<a href='/topic/show?id=4a67128814c' target=_blank style='color:#2F92EE;'>#NMDA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12881, encryptionId=4a67128814c, topicName=NMDA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=838d2500169, createdName=12498cb5m13暂无昵称, createdTime=Fri Aug 12 12:35:13 CST 2022, time=2022-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333640, encodeId=21f613336407d, content=<a href='/topic/show?id=1a1de07305e' target=_blank style='color:#2F92EE;'>#疾病负担#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70730, encryptionId=1a1de07305e, topicName=疾病负担)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/B389FA68ECBF51BE2FE14093CF61F6AE/100, createdBy=eb8e2500096, createdName=夏天与十三菇凉, createdTime=Sat Jun 25 07:35:13 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343623, encodeId=37a6134362369, content=<a href='/topic/show?id=928a849314c' target=_blank style='color:#2F92EE;'>#脑炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84931, encryptionId=928a849314c, topicName=脑炎)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Sat Jun 25 07:35:13 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
    2023-06-03 yinhl1978
  8. 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status=1, ipAttribution=)]
  9. 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status=1, ipAttribution=)]
  10. 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