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| 低三碘甲腺原氨酸综合征与抗N-甲基-D-天冬氨酸受体脑炎严重程度及预后的相关分析 |
| 毛晓薇1,侯媌媌2,王宗文3,李占肖1,毕晓莹1,蒋建明1* |
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(1. 海军军医大学(第二军医大学)第一附属医院神经内科, 上海 200433;
2. 上海交通大学医学院附属新华医院神经内科, 上海 200092;
3. 同济大学附属天佑医院神经外科, 上海 200331
*通信作者) |
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| 摘要: |
| 目的 探讨抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者出现低三碘甲腺原氨酸（T3）综合征与疾病严重程度及预后的关系。方法 回顾性分析2016年1月至2021年1月海军军医大学（第二军医大学）第一附属医院确诊的32例抗NMDAR脑炎患者的临床资料。根据入院后首次测定的血清游离三碘甲腺原氨酸（FT3）水平，将患者分为低T3综合征组及甲状腺功能正常组，并比较两组患者的人口学信息、临床特征等。根据患者发病后2～4周时的改良Rankin量表（mRS）评分，将患者分为预后良好组（mRS评分＜3分）和预后不良组（mRS评分≥3分），并比较两组患者临床特征及实验室检查结果。采用Pearson双变量相关分析探究低T3综合征与抗NMDAR脑炎严重程度及预后的相关性。结果 32例患者中有14例（43.75%）出现低T3综合征。与甲状腺功能正常组相比，低T3综合征组患者的意识障碍发生率、入院时mRS评分、癫痫发作率、并发肺部感染率、头颅MRI异常率、死亡率均较高（P均＜0.05）。预后不良组合并低T3综合征、癫痫持续状态、发热、并发肺部感染的患者比例均高于预后良好组（P均＜0.05）。相关分析结果显示，FT3水平与mRS评分呈负相关（r＝－0.514，P＝0.003）。结论 抗NMDAR脑炎患者甲状腺激素水平改变可能与体内自我保护机制有关，可能是一种潜在的重症抗NMDAR脑炎患者不良预后的生物标志物。常规监测FT3水平对抗NMDAR脑炎患者进行危险分层及预后判断具有重要的临床意义。 |
| 关键词: 低三碘甲腺原氨酸综合征 正常甲状腺病态综合征 抗N-甲基-D-天冬氨酸受体脑炎 预后 |
| DOI：10.16781/j.CN31-2187/R.20230139 |
| 投稿时间：2023-03-26修订日期：2023-09-04 |
| 基金项目:促进市级医院临床技能与临床创新能力三年行动计划项目（SHDC2020CR1038B）. |
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| Correlation analysis of low triiodothyronine syndrome with severity and prognosis of anti-N-methyl-D-aspartate receptor encephalitis |
| MAO Xiaowei1,HOU Miaomiao2,WANG Zongwen3,LI Zhanxiao1,BI Xiaoying1,JIANG Jianming1* |
(1. Department of Neurology, The First Affiliated Hospital of Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;
3. Department of Neurosurgery, Tianyou Hospital, Tongji University, Shanghai 200331, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the correlation of low triiodothyronine (T3) syndrome with the severity and prognosis of patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Methods The clinical data of 32 patients with anti-NMDAR encephalitis diagnosed in The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 2016 to Jan. 2021 were retrospectively analyzed. According to the serum free triiodothyronine (FT3) level measured for the first time after admission, the patients were divided into low T3 syndrome group and normal thyroid function group, and the demographic information and clinical characteristics of the 2 groups were compared. According to the modified Rankin scale (mRS) score at 2-4 weeks after onset, the patients were divided into good prognosis group (mRS＜3) and poor prognosis group (mRS≥3), and the clinical characteristics and laboratory findings of the 2 groups were compared. Pearson bivariate correlation analysis was used to explore the correlation of low T3 syndrome with the severity and prognosis of anti-NMDAR encephalitis. Results Among the 32 patients, 14 (43.75%) had low T3 syndrome. Compared with the patients in the normal thyroid function group, the patients in the low T3 syndrome group had higher incidence of consciousness disorder, higher mRS score at admission, higher rates of epilepsy and pulmonary infection, higher abnormal rate of cranial magnetic resonance imaging, and higher mortality (all P＜0.05). The proportions of patients with poor prognosis combined with low T3 syndrome, status epilepticus, fever, or pulmonary infection were higher than those of patients with good prognosis (all P＜0.05). Correlation analysis showed that FT3 level was negatively correlated with mRS scores (r＝－0.514，P＝0.003). Conclusion The change of thyroid hormone levels in patients with anti-NMDAR encephalitis may be related to the self-protection in vivo, and may be a potential biomarker of poor prognosis in patients with severe anti-NMDAR encephalitis. Routine monitoring of FT3 level has important clinical significance in risk stratification and prognosis prediction of anti-NMDAR encephalitis patients. |
| Key words: low triiodothyronine syndrome euthyroid sick syndrome anti-N-methyl-D-aspartate receptor encephalitis prognosis |
