中风与神经疾病杂志2025，Vol.42Issue(7)：631-636,6.DOI:10.19845/j.cnki.zfysjjbzz.2025.0121
自身免疫性脑炎诊断延迟的相关因素研究
Influencing factors for delayed diagnosis of autoimmune encephalitis
摘要
Abstract
Objective To summarize common antibody types and clinical symptoms during the acute phase of auto-immune encephalitis(AE),to investigate the influencing factors for delayed diagnosis,and ultimately to reduce misdiag-nosis rate,improve the prognosis of patients,and reduce medical expenses.Methods Antibody-positive AE patients who were diagnosed in 7 grade A tertiary hospitals from different provinces in China from 2018 to 2022 were enrolled,and related clinical data were collected.Univariate and multivariate logistic regression analyses were used to identify the influ-encing factors for delayed diagnosis(time from symptom onset to confirmed diagnosis>4 weeks),and the receiver operat-ing characteristic curve and the nomogram predictive model were constructed.The calibration curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess the degree of calibration of the nomogram predictive model,and a deci-sion curve analysis was used to assess the clinical effectiveness of the nomogram.Results A total of 394 AE patients who met the inclusion and exclusion criteria were enrolled,among whom there were 226 male patients(57.4%).The median length of hospital stay was 16(12,23)days for all patients,and 89 patients(22.6%)had a history of treatment in the in-tensive care unit.Of all patients,171(43.4%)experienced delayed diagnosis.Age(OR=1.016),memory impairment(OR=2.337),hallucination(OR=1.665),and sleep disorders(OR=1.818)were independent risk factors for delayed di-agnosis.Of all patients,329(83.5%)were misdiagnosed before the confirmed diagnosis of AE.During the acute phase,332 patients(84.3%)presented with psychiatric and behavioral abnormalities,289(73.4%)had symptomatic epilepsy,258(65.5%)had cognitive impairment,and 154(39.1%)had sleep disorders.The CASE scale score was(9.4±4.1)on admission.Electroencephalographic abnormalities were observed in 294 patients(74.6%),and magnetic resonance imag-ing abnormalities were detected in 210 patients(53.3%),with lesions mainly located in the temporal and frontal lobes.Conclusion Delayed diagnosis of AE is common in China,which is mainly associated with an old age,and memory im-pairment,hallucination,and sleep disorders are also risk factors for delayed diagnosis.关键词
自身免疫性脑炎/确诊延迟/影响因素Key words
Autoimmune encephalitis/Delayed diagnosis/Influencing factors分类
医药卫生引用本文复制引用
杨蕾,潘远航,王小木,费笑非,李晨蔚,朱哲,高玉雯,刘永红,张歆博..自身免疫性脑炎诊断延迟的相关因素研究[J].中风与神经疾病杂志,2025,42(7):631-636,6.基金项目
陕西省重点研发计划(2023-YBSF-199) （2023-YBSF-199）
陕西省重点研发计划(S2021-YF-YBSF-0310) （S2021-YF-YBSF-0310）
西京医院新技术新业务(2024HLJS17) （2024HLJS17）
