【摘要】 目的 明确利妥昔单抗治疗抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的效果，并观察其对患者淋巴细胞亚群的影响。方法 回顾性纳入和分析2022年1月至2024年3月我院诊治的抗NMDAR脑炎患者，分为观察组(13例)和对照组(14例)观察组在一线治疗后桥接使用至少2剂利妥昔单抗治疗，对照组仅接受一线治疗，观察两组疗效和治疗后外周血淋巴细胞亚群比例变化。结果 治疗3个月后两组改良Rankin量表(mRS)评分均显著改善(均P<0.05)。治疗前后观察组mRS评分下降值大于对照组(P<0.05)。观察组桥接利妥昔单抗治疗后外周血CD4/CD8比值降低(P<0.05),CD3~+T淋巴细胞和CD8~+ T淋巴细胞比例增加(P<0.05),B淋巴细胞比例明显下降(P<0.05)。对照组治疗前后外周血淋巴细胞比例没有显著性差异。结论 利妥昔单抗可能通过降低CD4/CD8比值和耗竭B淋巴细胞共同起到调节机体免疫功能、改善抗NMDAR脑炎预后的作用。更多还原

【Abstract】 Objective To determine the efficacy of rituximab in the treatment of anti-N-methyl-D-aspartate receptor(NMDAR) encephalitis and observe its effect on peripheral blood lymphocyte subsets. Methods A retrospective study included 27 patients with anti-NMDAR encephalitis from January 2022 to March 2024, divided into the observation group(13 cases) and the control group(14 cases). The observation group received rituximab after first-line treatment, while the control group only received first-line treatment. Modified Rankin Scale(mRS) scores before and 3 months after treatment were compared between the two groups, and the proportions of peripheral blood lymphocyte subsets were analyzed.Results Three months after treatment, mRS scores in both groups were significantly improved compared with before treatment(both P<0.05). The decrease in mRS score in the observation group was significantly greater than that in the control group(P<0.05). In the observation group, the proportion of CD4~+/CD8~+ and B cells significantly decreased, the proportions of CD3~+T cells and CD8~+T cells significantly increased(all P<0.05). There were no significant differences in lymphocyte subset proportions before and after treatment in the control group(all P>0.05). Conclusions Rituximab could improve the prognosis and modulate the immunity of patients with anti-NMDAR encephalitis by increasing the proportions of CD3~+ and CD8~+ T cells and depleting B cells.更多还原