儿童自身免疫性脑炎预后影响因素分析

Analysis of Prognostic Influencing Factors in Children with Autoimmune Encephalitis

摘要: 目的：探讨影响儿童自身免疫性脑炎(AE)预后的相关因素。方法：回顾性分析2018年1月至2023年6月我院收治的41例儿童AE患者的临床资料。根据出院6个月后改良Rankin量表(mRS)评分将患儿分为预后良好组(mRS ≤ 2分，n = 28)和预后不良组(mRS > 2分，n = 13)。收集并比较两组的临床特征、实验室检查、治疗及随访资料，采用Logistic回归分析影响预后的独立危险因素。结果：单因素分析显示，预后不良组在入院时mRS评分高(≥4分)、延迟免疫治疗(>30天)、合并中枢性低通气、ICU住院时间长(>14天)、脑电图重度异常及MRI异常的比例显著高于预后良好组(P < 0.05)。多因素Logistic回归分析显示，延迟免疫治疗(>30天) (OR = 5.632, 95% CI: 1.245~25.478)和合并中枢性低通气(OR = 4.785, 95% CI: 1.032~22.189)是儿童AE预后不良的独立危险因素(P < 0.05)。结论：儿童AE总体预后较为乐观，但延迟免疫治疗和出现中枢性低通气是预后不良的独立危险因素。应重视早期诊断和及时免疫治疗，对合并中枢性低通气的患儿需加强重症监护和呼吸支持。

Abstract: Objective: To investigate the factors influencing the prognosis of children with autoimmune encephalitis (AE). Methods: The clinical data of 41 children with AE admitted to our hospital from January 2018 to June 2023 were retrospectively analyzed. According to the modified Rankin Scale (mRS) score at 6 months after discharge, they were divided into a good prognosis group (mRS ≤ 2, n = 28) and a poor prognosis group (mRS > 2, n = 13). The clinical characteristics, laboratory examinations, treatment, and follow-up data of the two groups were collected and compared. Logistic regression was used to analyze independent risk factors affecting prognosis. Results: Univariate analysis showed that the poor prognosis group had significantly higher proportions of high mRS score at admission (≥4), delayed immunotherapy (>30 days), combined central hypoventilation, longer ICU stay (>14 days), severe EEG abnormalities, and MRI abnormalities than the good prognosis group (P < 0.05). Multivariate logistic regression analysis showed that delayed immunotherapy (>30 days) (OR = 5.632, 95% CI: 1.245~25.478) and combined central hypoventilation (OR = 4.785, 95% CI: 1.032~22.189) were independent risk factors for poor prognosis in children with AE (P < 0.05). Conclusion: The overall prognosis of children with AE is relatively good, but delayed immunotherapy and the occurrence of central hypoventilation are independent risk factors for poor prognosis. Early diagnosis and timely immunotherapy are crucial for improving outcomes. Children with central hypoventilation require enhanced intensive care and respiratory support.