Clinical And Immunological Indicators Of Cyclophosphamide In The Treatment Of Autoimmune Encephalitis

Background:Autoimmune Encephalitis is a type of inflammation of the brain parenchyma mediated by autoimmune antibodies.The pathological changes are mainly gray matter and neuron involvement.Among them,AE patients with tumors,mainly through the intracellular antibodies of neurons to immune response,often cause irreversible neuronal damage.Since 2007,anti-neuron surface or synaptic protein autoantibodies have been found one after another.The target antigen is located on the surface of neuron cells.It mainly causes relatively reversible neuron dysfunction through humoral immune mechanisms,and the immunotherapy effect is good.AE immunotherapy can be divided into three types,including first-line immunotherapy,second-line immunotherapy and alternative therapy.Cyclophosphamide,as an immunotherapy drug for AE,is mainly used for AE patients with poor first-line immunotherapy.At present,there are few clinical studies on the use of cyclophosphamide in the treatment of AE.Therefore,this study intends to evaluate the efficacy,safety and related immune status indicators of cyclophosphamide in the treatment of AE.Objective:To analyze AE patients treated with cyclophosphamide and to further evaluate the efficacy,safety and related immunological parameters of AE patients.To provide a basis theory for the indications and specific protocols for cyclophosphamide treatment of AE.Methods:We collected 48 AE patients who had been treated in the Department of Neurology,Shandong Provincial Hospital and the Department of Neurology,Liaocheng Brain Hospital from February 2016 to February 2018.We collect basic characteristics and clinical follow-up,Patients with clinical outcomes were assessed using a modified Rankin score(mRS).laboratory tests were collected,including serum IgG levels,absolute values of peripheral blood lymphocytes,CD19(+)B cells,CD4(+)T cells,and CD8(+)T cells.The above data was analyzed by software IBM SPSS Version 17Results:Serum IgG levels(p<0.001)and peripheral blood CD19(+)B cell levels(p=0.01)after treatment were statistically differences from pre-treatment.There were no statistical differences in blood CD4(+)T cell levels(p=0.461)and CD8(+)T cell levels(p=0.631).The mRS(0.31±0.45)was significantly improved after cyclophosphamide treatment compared with pre-treatment mRS(4.22±1.78)(p<0.001).32/48 patients(66.67%)and 48/48 patients(100%)had good neurological function at the end of follow-up(mRS<2).Serum IgG levels decreased to a minimum within 4 months in treatment period.peripheral blood CD 19(+)B cell levels and mRS showed a gradual decline during treatment.Only a small number of the 48 patients had mild side effects during treatment period(n=4 for gastrointestinal reactions and,n=5 for headaches).Conclusion:Cyclophosphamide can improve neurological deficits and immune status of patients with AE,and it is safe and effective.