抗N-甲基-D-天冬氨酸受体脑炎患者血清orexin-A水平的变化及其临床意义

摘要

目的 观察抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患者血清增食欲素-A(orexin-A)水平的变化,并分析其临床意义.方法 选择2010年1月至2014年12月在本科治疗的14例抗NMDAR脑炎患者病例组,另外选取14例同期体检健康成人设置对照.比较病例组患者于对照组血清健康orexin-A水平的差异.采用二分类Logistic回归分析法评估血清健康orexin-A水平对抗NMDAR脑炎的影响,采用ROC曲线法评估血清orexin-A用于抗NMDAR脑炎诊断准确性.采用改良的RANKIN量表(mRS)评估患者预后情况.结果 病例组患者血清orexin-A水平明显低于对照组(P=0.02).二分类Logistic回归分析结果显示血清orexin-A是抗NMDAR脑炎的保护因素(OR=2.01;95％CI,1.16-3.17;P＜0.01).根据ROC曲线,orexin-A诊断抗NMDAR脑炎的最佳界限值为384.7ng·L-1,其特异性为85.7％,敏感度为71.4％.AUC为0.806(95％CI,0.639-0.973).预后良好组与预后不良组比较,两组血清orexin-A水平差异无统计学意义(P=0.61).结论 抗NMDAR脑炎患者血清orexin-A显著降低,但血清orexin-A水平与患者预后情况无明显关系.%Objective To observe the change of serum orexin-A in patients with anti-N-methyl-D-aspartate receptor encephalitis (NMDAR).And to analysis its clinical meaning.Method Fourteen patients with NMDAR from January 2010 to December 2014 were recruited to participate in the study as case group.fourteen healthy physical examination patients in our hospital physical examination centre in same time were selected as control group.To compare the differences of the serum orexin-A level between case group and control group.Multiariable Logistic regression analysis was used to evluate the effect of serum orexin-A on autoimmune encephalitis.Receiver Operating Characteristic (ROC) curve wae used to evluate the accuracy of serum orexin-A in diagnosing NMDAR.Modified Rankin Scale (mRS) was adopted to evaluate the prognosis.Results The level of serum orexin-A in the case group was lower than the control group (P=0.02).Multiariable Logistic regression analysis showed that the serum orexin-A levels (OR=2.01;95％CI,1.16-3.17;P＜0.01) were protective factor for NMDAR.Meanwhile,based on the ROC curve,the optimal cutoff value of serum orexin-A levels as an indicator for auxiliary diagnosis of autoimmune encephalitis was projected to be 384.7ng · L-1,which yielded a specificity of 85.7％ and a sensitivity of 71.4％,with the area under the curve at 0.806 (95％CI,0.639-0.973).There was no significant difference between good prognosis group and poor prognosis group about the serum orexin-A level (P=0.61).Conclusion For the patients with NMDAR,the serum orexin-A levels decreased significantly.However,serum orexin-A levels didn't relate with the prognosis of NMDAR.