目的:探讨以癫痫持续状态为首发症状的自身免疫性脑炎的相关影响因索。

方法:收集2018年至2022年厦门大学附属东南医院神经内科收治的以癫痫持续状态为首发症状的自身免疫性脑炎患者34例的临床资料,其中包括年龄、性别、白细胞计数、C反应蛋白、中性粒细胞与淋巴细胞比率、白蛋白、腰穿脑脊液压力、脑脊液相关检查结果、脑电图、头颅MRI等,根据病情最重时Glasgow评分,将入组患者分为重症组(Glasgow≥8分,24例) 和非重症组( Glasgow<8分,10例),分析以癫痫持续状态为首发症状的自身免疫性脑炎患者疾病严重程度的影响因素。

结果:单因素分析发现2组的中性粒细胞与淋巴细胞比率.脑脊液葡萄糖、头颅MRI异常率有统计学差异(P<0.05),进一步行二元Logistic回归分析发现重症组头颅MRI异常率较非重症组差异有统计学意义。以头颅MRI是否异常与AE患者严重程度做ROC曲线，得出曲线下面积为 0.85( P= 0.001 )。

结论:头颅MRI异常是以癫痫持续状态为首发症状的自身免疫性脑炎发展为重症的独立危险因素。

Objective: To explore the related influencing factors of autoimmune encephalitis with status epilepticus as the first symptom.

Methods: The clinical data of 34 patients with autoimmune encephalitis with status epilepticus as the first symptom admitted by the department of neurology of southeast hospital affiliated to Xiamen university from 2018 to 2022 were collected, including age,gender, white blood cell count, C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), albumin, lumbar puncture pressure, cerebrospinal fluid related examination results, electroencephalogram, cranial MRI, etc. According to Glasgow score at the time of the worst condition, the enrolled patients were divided into severe group (Glasgow> 8 points, 24 patients) and non severe group (Glasgow <8 points, 10 patients). Analyze the factors influencing the severity of autoimmune encephalitis patients with status epilepsy as the initial symptom.

Results: Univariate analysis revealed statistically significant differences in NLR, cerebrospinal fluid glucose, and head MRI abnormality rates between the two groups (P< 0.05). Further binary logistic regression analysis revealed that there was a statistically significant difference in head MRI abnormality rates between the severe group and the non severe group. The ROC curve was drawn based on whether the head MRI was abnormal and the severity of autoimmune encephalitis patients, and the area under the curve was 0.85 (P= 0.001).

Conclusion: Abnormal cranial MRI was an independent risk factor for the progression of autoimmune encephalitis with status epileptic as the initial symptom to severe illness.