| Objective The clinical features of autoimmune encephalitis（AE）were analyzed retrospectively,meanwhile,the correlation between neutrophil-to-lymphocyte ratio（NLR）and lymphocyte-to-monocyte ratio（LMR）in peripheral blood and the severity of AE was investigated,It provides more clinical basis for the early identification,diagnosis and judgment of disease progression of AE.Methods A total of 42 patients who met the diagnostic criteria[1]of autoimmune encephalitis in the Department of Neurology,General Hospital of Ningxia Medical University and Cardiovascular and Cerebrovascular Hospital from January 2016 to September 2022 were selected.At the same time,43 healthy subjects matched with AE patients in Ningxia Medical University General Hospital were selected as the control group.The basic information and clinical routine diagnosis and treatment data of AE with different antibody types were collected,Including gender,age,White blood cells（WBC）,Lymphocyte count（LY）,Neutrophil count（NEUT）,Monocytes count（MO）,Platelet count（PLT）,Albumin（ALB）,Modified Rankin Scale（m RS）,Clinical Assessment Scale for Autoimmune Encephalitis（CASE）,Cerebrospinal fluid white blood cell count,cerebrospinal fluid biochemistry,Electroencephalogram（EEG）and Magnetic Resonance Imaging（MRI）,etc.The results were analyzed and the clinical characteristics of different antibody types were compared;The peripheral blood NLR and LMR of patients with AE were calculated,and the correlation analysis was performed according to the m RS score（table 1）and CASE（table 2）to evaluate the severity of the disease at admission.Results 1.Among the 42 AE patients,28（67%）were male and 14（33%）were female,Among them,anti-NMDAR antibody encephalitis and anti-LGI1 antibody encephalitis were more male than female,accounting for 67%and 64%respectively,The age range of onset was 16-78 years old,with an average age of 40 years old.2.In this study,the proportions of various antibody types were:anti-NMDAR antibody encephalitis 15（60%）cases,anti-LGI1 antibody encephalitis 11（26%）cases,anti-GAD65antibody encephalitis 4（10%）cases,anti-GFAP antibody encephalitis 4（10%）cases,anti-CASPR2 antibody encephalitis 3（7%）cases,anti-MOG antibody encephalitis 3（7%）cases,double antibody was positive in 2（5%）cases.Among the 42 AE patients,23（55%）had prodromal symptoms,including fever,headache,dizziness,nausea and vomiting.In this study,27（64%）cases of epilepsy were the most common clinical manifestations,followed by20（48%）cases of abnormal mental behavior,14（33%）cases of cognitive impairment,9（21%）cases of sleep disorders,6（14%）cases of consciousness disorders,7（17%）cases of speech disorders and 5（12%）cases of movement disorders.3.Brain MRI examination of 42 AE patients showed normal results in 20（48%）and abnormal results in 22（52%）.There were 38 patients with AE who underwent complete EEG examination,of which 10（26%）were normal,and 7（18%）were mild,18（47%）were moderate,and 3（8%）were severe.4.Compared with the control group,it was found that the levels of NLR,PLR,WBC,NEUT and MO in peripheral blood of AE patients were significantly higher（P<0.001）,while the levels of LMR,LY and ALB in peripheral blood were significantly lower（P<0.001）.5.According to the severity of AE disease,the patients were divided into mild group（MD group）and severe group（SD group）,and the differences between the two groups was analyzed,it was found that the level of NLR in peripheral blood of SD group was significantly higher than that in MD group（P<0.01）.At the same time,there were significant statistical differences in WBC,NEUT and MO between the two groups（P<0.01）,however,the LMR of peripheral blood in SD group was significantly lower than that in MD group（P<0.01）.6.According to the results of Spearman correlation analysis,NLR was positively correlated with CASE score of AE patients（r=0.480,P=0.001）,WBC was positively correlated with CASE score（r=0.585,P<0.001）,NEUT was positively correlated with CASE score（r=0.601,P<0.001）,and LMR was negatively correlated with CASE score（r=-0.392,P=0.010）.CASE score was positively correlated with m RS score（r=0.853,P<0.001）.7.In this study,it was found that WBC,NEUT and NLR were correlated with severe AE in univariate regression analysis,and multivariate logistic regression analysis showed that there was still a significant statistical difference between NLR and CASE score（OR=1.404,95%CI:1.009-1.954,P=0.044）,The results showed that the increase of NLR in peripheral blood was an independent risk factor for the exacerbation of AE.According to ROC curve,the sensitivity and specificity of NLR as an indicator to predict severe AE diseases were 81.3%,73.1%,the optimal cutoff value was 4.34,and the AUC was 0.779（95%CI:0.623-0.934）P<0.05.Conclusion 1.In this study,anti-NMDAR antibody encephalitis and anti-LGI1antibody encephalitis accounted for the most antibody types in AE patients.Mental behavior abnormalities and seizures were the most common clinical manifestations in all antibody types.2.Among 38 patients with AE,most of the perfected electroencephalogram was abnormal,among which anti-CASPR2 antibody encephalitis,anti-MOG antibody encephalitis and double antibody encephalitis were abnormal.3.The increase of NLR in peripheral blood is an independent risk factor for the e xacerbation of AE,and can be used as one of the biomarkers to assess the severity o f the disease. |
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