Effect of protein A immunoadsorption nursing process on the efficacy in patients with anti-NMDAR encephalitis

doi:10.3760/cma.j.cn441417-20240806-03032

Abstract

Abstract:

Objective　To investigate the effect of protein A immunoadsorption (IA) on anti-N‑methyl‑D‑aspartate receptor (NMDAR) encephalitis and the significance of nursing intervention measures. Methods　A total of 10 adult patients with anti-NMDAR encephalitis who underwent IA treatment in the Department of Neurology, Guangdong Sanjiu Brain Hospital from April 2021 to August 2022 were collected. The key points of nursing were the patients' evaluation before IA treatment, the prescription of IA treatment, and the prevention and response of events during treatment. The anti-NMDAR antibodies in serum and cerebrospinal fluid were tested on the day before IA treatment and the next day after treatment, and the changes in symptoms and scores of Activity of Daily Living Scale (ADL), Brief Psychiatric Rating Scale (BPRS), and Mini Mental Status Examination (MMSE) were evaluated on the day before IA treatment and the day before discharge, as well as adverse reactions during treatment. Wilcoxon signed rank test was used for statistical analysis. Results　Among the 10 patients, there were 6 males and 4 females, aged (34.40±11.22) years. Before treatment, the serum anti-NMDAR antibody was positive in 10 patients [antibody titer ranged 1: (30-320)], and cerebrospinal fluid anti-NMDAR antibody was positive in 9 patients (antibody titer ranged from negative to 1:100). Each patient underwent a course of IA treatment, a total of 5 times, once every other day. Ten patients completed a total of 50 treatments, and 1 hypotension and 1 skin allergic reaction occurred, without other discomfort. Compared with those before IA treatment, the serum anti-NMDAR antibody titer of the 10 patients decreased by 1:n on the next day after treatment [10.0 (7.5, 10.0) vs. 30.0 (30.0, 100.0), Z=-2.869, P=0.004], and the cerebrospinal fluid anti-NMDAR antibody titer of the 9 patients also decreased by 1:n [10 (0,10) vs. 30 (10,100), Z=-2.539, P=0.011]. In some patients, the antibody turned negative. Compared with those before IA treatment, the BPRS score decreased on the day before discharge, and the ADL and MMSE scores increased (all P<0.001). Conclusion　IA is safe and effective in the treatment of anti-NMDAR encephalitis.

Key words:

Autoimmune encephalitis, Anti-N?methyl?D?aspartate receptor antibody, Protein A immunoadsorption, Nursing

摘要：

目的　探讨蛋白A免疫吸附（protein A immunoadsorption，IA）在抗N-甲基-D-天门冬氨酸受体（N‑methyl‑D‑aspartate receptor，NMDAR）脑炎患者中的应用效果及护理干预措施的意义。方法　收集2021年4月至2022年8月在广东三九脑科医院神经内科行IA治疗的10例成年抗NMDAR脑炎患者，重点做好患者治疗前评估，确定IA治疗处方，治疗时注意各种突发事件的预防与应对，于IA治疗前一天和疗程结束后次日评估患者血清和脑脊液抗NMDAR抗体结果，于IA治疗前一天和出院前一天评估患者的症状和日常生活能力量表（Activity of Daily Living Scale，ADL）、简明精神病评定量表（Brief Psychiatric Rating Scale，BPRS）、简易精神状态评价量表（Mini Mental Status Examination，MMSE）评分变化，以及治疗期间的不良反应。采用Wilcoxon符号秩检验进行统计学分析。结果　10例患者中，男6例，女4例，年龄（34.40±11.22）岁。治疗前，10例患者血清抗NMDAR抗体阳性［抗体滴度在1∶（30～320）之间］，9例患者脑脊液抗NMDAR抗体阳性（抗体滴度在阴性～1∶100之间）。每例患者均行一个疗程IA治疗，共5次，隔天一次，10例患者共完成50例次治疗，其中出现1次低血压、1次皮肤过敏反应，无其他不适。与IA治疗前相比，疗程结束后次日测得10例患者血清抗NMDAR抗体滴度1∶n下降［10.0（7.5，10.0）比30.0（30.0，100.0），Z=-2.869，P=0.004］，9例患者脑脊液抗NMDAR抗体滴度1∶n亦下降［10（0，10）比30（10，100），Z=-2.539，P=0.011］，部分患者经IA治疗后抗体转阴。与IA治疗前相比，出院前一天患者BPRS评分下降，ADL、MMSE评分升高（均P<0.001）。结论　IA治疗抗NMDAR脑炎安全有效。

关键词:

自身免疫性脑炎, 抗N-甲基-D-天门冬氨酸受体抗体, 蛋白A免疫吸附, 护理

Zhang Kanghua, Liu Zhihong, Li Dandan, Luo Liting, Xiang Lingmei, Kuang Zuying, Xi Lingru, Wang Zhanghang.

Effect of protein A immunoadsorption nursing process on the efficacy in patients with anti-NMDAR encephalitis [J]. International Medicine and Health Guidance News, 2025, 31(3): 505-510.

张康华刘志红李丹丹罗莉婷向玲妹匡祖颍奚玲如王展航.

蛋白A免疫吸附护理操作流程对抗NMDAR脑炎患者疗效的影响 [J]. 国际医药卫生导报, 2025, 31(3): 505-510.

References

[1] Dalmau J, Tüzün E, Wu HY, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma[J]. Ann Neurol, 2007, 61(1):25-36. DOI: 10.1002/ana.21050.
[2] 李志刚,唐晓梅,钟水生.抗NMDA受体脑炎儿童与成人临床特征和预后的对比分析[J].国际医药卫生导报,2023,29(14):1996-2000. DOI:10.3760/cma.j.issn.1007-1245. 2023.14.016.
[3] Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis[J]. Lancet Neurol, 2016, 15(4):391-404. DOI: 10.1016/S1474-4422(15)00401-9.
[4] 中华医学会神经病学分会神经感染性疾病与脑脊液细胞学学组.中国自身免疫性脑炎诊治专家共识(2022年版)[J].中华神经科杂志,2022,55(9):931-949. DOI:10.3760/cma.j.cn113694-20220219-00118.
[5] Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study[J]. Lancet Neurol, 2013, 12(2):157-165. DOI: 10.1016/S1474-4422(12)70310-1.
[6] 刘磊,宋兆慧,郭晶,等.国人45例抗N-甲基-D-天冬氨酸受体脑炎病例分析[J].中华神经科杂志,2014,47(7):474-481. DOI:10.3760/cma.j.issn.1006-7876.2014.07.009.
[7] 中华医学会神经病学分会.中国自身免疫性脑炎诊治专家共识[J].中华神经科杂志,2017,50(2):91-98. DOI:10.3760/cma.j.issn.1006-7876.2017.02.004.
[8] 宋建成,费立鹏,张培琰,等.简明精神病评定量表中各分量表的评价[J].临床精神医学杂志,2001,11(2):86-88. DOI:10.3969/j.issn.1005-3220.2001.02.009.
[9] 盛嘉玲,丁关元,孙忠,等.住院精神病患者日常生活能力评定量表的信度及效度检验[J].中国临床康复,2004,8(12):2201-2203. DOI:10.3321/j.issn:1673-8225.2004.12.001.
[10] 侯岩芳,张艳峰,池金凤,等.日常生活活动能力量表在分级护理管理中的应用研究[J].中国实用护理杂志,2007,23(28):6-8. DOI:10.3760/cma.j.issn.1672-7088.2007. 28.003.
[11] 罗国刚,韩建峰,屈秋民,等.简易精神状态检查适用人群及影响因素[J].中国心理卫生杂志,2002,16(4):246-248,233.DOI:10.3321/j.issn:1000-6729.2002.04.008.
[12] Vora NM, Holman RC, Mehal JM, et al. Burden of encephalitis-associated hospitalizations in the United States, 1998-2010[J]. Neurology, 2014, 82(5):443-451. DOI: 10.1212/WNL.0000000000000086.
[13] Padmanabhan A, Connelly-Smith L, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the writing committee of the American Society for Apheresis: the eighth special issue[J]. J Clin Apher, 2019, 34(3):171-354. DOI: 10.1002/jca.21705.
[14] Connelly-Smith L, Alquist CR, Aqui NA, et al. Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the writing committee of the American Society for Apheresis: the ninth special issue[J]. J Clin Apher, 2023, 38(2):77-278. DOI: 10.1002/jca.22043.
[15] 中国免疫学会神经免疫分会.中国神经免疫病免疫吸附治疗临床应用指南[J].中国神经免疫学和神经病学杂志,2022,29(2):81-84. DOI:10.3969/j.issn.1006-2963.2022. 02.001.
[16] 李莉莉,阮恒芳,沈利平,等.视神经脊髓炎谱系疾病患者免疫吸附治疗的护理[J].中国实用护理杂志,2021,37(4):286-290. DOI:10.3760/cma.j.cn211501-20200319- 01276.
[17] 吴炳华,刘春生,刘夕珍.全血免疫吸附治疗神经免疫性疾病的护理[J].中华现代护理杂志,2012,18(3):326-327. DOI:10.3760/cma.j.issn.1674-2907.2012.03.030.
[18] 李家燕,唐业莹,黄玲,等.血浆吸附治疗自身免疫性疾病患者的护理[J].中国急救复苏与灾害医学杂志,2017,12(3):267-268. DOI:10.3969/j.issn.1673-6966.2017.03.022.
[19] Dorst J, Fangerau T, Taranu D, et al. Safety and efficacy of immunoadsorption versus plasma exchange in steroid-refractory relapse of multiple sclerosis and clinically isolated syndrome: a randomised, parallel-group, controlled trial[J]. EClinicalMedicine, 2019, 16:98-106. DOI: 10.1016/j.eclinm.2019.10.017.
[20] Li R, Wang J, Li C, et al. Rescue immunoadsorption treatment for neuromyelitis optica spectrum disorder attacks unresponsive to intravenous methylprednisolone[J]. J Neuroimmunol, 2021, 356:577604. DOI: 10.1016/j.jneuroim.2021.577604.
[21] Dogan Onugoren M, Golombeck KS, Bien C, et al. Immunoadsorption therapy in autoimmune encephalitides[J]. Neurol Neuroimmunol Neuroinflamm, 2016, 3(2):e207. DOI: 10.1212/NXI.0000000000000207.
[22] Zhang B, Yu D, Zhu Q, et al. Protein A immunoadsorption for the treatment of refractory anti-N-methyl-d-aspartate receptor encephalitis: a single-center prospective study[J]. J Neurol Sci, 2021, 428:117568. DOI: 10.1016/j.jns.2021.117568.
[23] Chen J, Feng L, Zhou H, et al. Immunoadsorption with staphylococcal protein A column in autoimmune encephalitis[J]. Transfusion, 2021, 61(11):3272-3276. DOI: 10.1111/trf.16644.
[24] 王玉鸽,马晓宇,杨渝,等.蛋白A免疫吸附治疗自身免疫脑炎疗效的回顾性分析[J].中国神经免疫学和神经病学杂志,2021,28(3):224-227. DOI:10.3969/j.issn.1006-2963. 2021.03.011.
[25] 陈香美.血液净化标准操作规程:2021版[M].北京:人民卫生出版社,2021.
[26] 王佩,胡绍毅,张艳.经外周静脉穿刺中心静脉置管患者透明敷料过敏后应用水胶体敷料的护理体会[J].世界临床医学,2016,10(20):203,206.