内科理论与实践

内科理论与实践 ›› 2025, Vol. 20 ›› Issue (05): 365-370.doi: 10.16138/j.1673-6087.2025.05.03

• 论著 • 上一篇    下一篇

自身免疫性脑炎抗体谱系特征与合并肿瘤对预后的影响

万文斌, 谢冲, 姚小英, 张瑛, 王刚()   

  1. 上海交通大学医学院附属仁济医院神经内科，上海　200127
  • 收稿日期:2025-08-28 接受日期:2025-09-24 出版日期:2025-12-10 发布日期:2025-12-26
  • 通讯作者: 王刚 E-mail:wanggang@renji.com

Characteristics of autoimmune encephalitis antibody profiles and the impact of coexisting tumors on prognosis

WAN Wenbin, XIE Chong, YAO Xiaoying, ZHANG Ying, WANG Gang()   

  1. Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Received:2025-08-28 Accepted:2025-09-24 Online:2025-12-10 Published:2025-12-26
  • Contact: WANG Gang E-mail:wanggang@renji.com

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摘要：

目的：探讨自身免疫性脑炎（autoimmune encephalitis，AE）患者的临床特征、抗体类型、治疗时机及肿瘤合并情况对疗效与预后的影响，为临床管理提供参考。方法：回顾性分析2020年1月至2025年6月在上海交通大学医学院附属仁济医院神经内科收治的203例AE患者的临床资料，收集其性别、年龄、病程、抗体类型及肿瘤筛查情况进行统计分析，评估上述因素对治疗效果的影响。同时，采用AE临床评估量表（clinical assessment scale for autoimmune encephalitis，CASE）评分系统对患者疗效进行评估。结果：共纳入203例AE患者，男性占56.2%，中位年龄50岁，亚急性病程为主（64.0%）。抗体谱呈现高度异质性，以抗N-甲基-D-天冬氨酸受体（N-methyl-D-aspartate receptor，NMDAR）抗体最常见（24.1%）。急性期治疗后总体改善率为79.8%，而显著改善率仅为11.3%。肿瘤合并率为15.3%，合并肿瘤的患者疗效略低于非肿瘤组。结论：AE的疗效受抗体特性、治疗时机、疾病严重程度及是否合并肿瘤等多种因素影响，及时免疫治疗对预后具有显著影响，早诊断、早治疗有助于改善预后。精准的抗体检测和系统的肿瘤筛查是改善AE患者预后的重要策略，未来临床管理应加强对上述因素的综合评估，以实现最佳治疗效果和改善患者长期预后。

关键词: 自身免疫性脑炎, 肿瘤, 肿瘤神经病学, 致病抗体, 疾病预后

Abstract:

Objective This study aims to investigate the impact of clinical characteristics, antibody types, timing of treatment, and tumor comorbidities on the efficacy and prognosis of patients with autoimmune encephalitis (AE), aiming to provide a reference for clinical management. Methods A retrospective analysis was conducted on the medical records of 203 AE patients admitted to the Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, from January 2020 to June 2025. Statistical analysis was performed on patients’ gender, age, disease course, antibody types, and tumor screening results to evaluate their impact on treatment efficacy. Additionally, the clinical assessment scale for autoimmune encephalitis (CASE) scoring system was used to assess treatment outcomes. Results A total of 203 AE patients were included in the study, in which 56.2% cases were male, a median age was 50 years, and most of the disease course was subacute (64.0%). The antibody profiles showed high heterogeneity, with N-methyl-D-aspartate receptor (NMDAR) antibodies being the most common (24.1%). Treatment outcomes revealed that an overall improvement rate is 79.8%, but the significant improvement rate was only 11.3%. The tumor comorbidity rate was 15.3%, and the efficacy of treatment in patients with tumors was slightly lower than that of the non-tumor group. Conclusions The efficacy of AE treatment is influenced by multiple factors, including antibody characteristics, timing of treatment, disease severity, and tumor comorbidities. Timely immunotherapy significantly impacts prognosis, and early diagnosis and treatment can improve clinical outcomes. Precise antibody testing and systematic tumor screening are crucial strategies for promoting the prognosis of AE patients. Future clinical management should strengthen comprehensive assessment of the above factors to achieve optimal treatment outcomes and enhance long-term prognosis.

Key words: Autoimmune encephalitis, Tumor, Neuro-oncology, Pathogenic antibodies, Disease prognosis

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