Coexisting anti-NMDAR and MOG antibody (anti-NMDAR-IgG+/MOG-IgG+)-associated encephalitis have garnered great attention. This study aimed to perform a secondary analysis to determine the clinical features of this disease. We searched several databases for related publications published prior to April 2021. A pooled analysis was conducted with the fixed-effects model using the Mante-Haenszel method (I 2 ≤ 50%), or the random-effects model computed by the DerSimonian-Laird method (I 2 > 50%). Stata software (version 15.0 SE) was used for the analyses. Nine observational studies and 16 case reports (58 cases with anti-NMDAR-IgG+/MOG-IgG+, 21.0 [8.5, 29.0] years, male 58.6%) were included. The incidences (95%CI) of anti-NMDAR-IgG+/MOG-IgG+ in the patients with serum MOG-IgG+ and CSF anti-NMDAR-IgG+ were 0.09 (0.02-0.19) and 0.07 (0.01-0.19), respectively. The median [IQR] of CSF anti-NMDAR antibody titer was 32 [10, 100], and the serum anti-MOG antibody titer was 100 [32, 320]. The prominent clinical symptoms were encephalitic manifestations, including seizures (56.9%) and abnormal behavior (51.7%), rather than demyelinating manifestations, such as speech disorder (34.5%) and optic neuritis (27.6%). Relapse occurred in 63.4% of anti-NMDAR-IgG+/MOG-IgG+ patients, in whom 50.0% of cases relapsed with encephalitic manifestations, and 53.8% relapsed with demyelinating manifestations. The common MRI changes were in the cortex or subcortex (70.7%) and brainstem (31.0%). 31.3% of patients presented with unilateral cerebral cortical encephalitis with epilepsy and 12.5% displayed bilateral frontal cerebral cortex encephalitis. Anti-NMDAR-IgG+/MOG-IgG+ patients showed more frequent mental behavior (OR, 95%CI, 68.38, 1.36-3,434.37), involuntary movement (57.86, 2.53-1,325.11), sleep disorders (195.00, 7.07-5,380.15), and leptomeninge lesions (7.32, 1.81-29.58), and less frequent optic neuritis (0.27, 0.09-0.83) compared to anti-NMDAR-IgG-/MOG-IgG+ patients and presented more common relapse (5.63, 1.75-18.09), preceding infection (2.69, 1.03-7.02), subcortical lesions (116.60, 4.89-2,782.09), basal ganglia lesions (68.14, 2.99-1,554.27), brainstem lesions (24.09, 1.01-574.81), and spinal cord lesions (24.09, 1.01-574.81) compared to anti-NMDAR-IgG+/MOG-IgG-. In conclusion, anti-NMDAR-IgG+/MOG-IgG+ was rarely observed, but the incidence rate of relapse was very high. The overall symptoms seemed to be similar to those of NMDAR encephalitis.

中文翻译：

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共存的抗 NMDAR 和 MOG 抗体相关脑炎的临床特征：系统评价和荟萃分析。

共存的抗 NMDAR 和 MOG 抗体（抗 NMDAR-IgG+/MOG-IgG+）相关性脑炎引起了极大的关注。本研究旨在进行二次分析以确定该疾病的临床特征。我们在多个数据库中搜索了 2021 年 4 月之前发表的相关出版物。 使用 Mante-Haenszel 方法 (I 2 ≤ 50%) 的固定效应模型或由 DerSimonian-Laird 计算的随机效应模型进行了汇总分析方法（I 2 > 50%）。Stata 软件（版本 15.0 SE）用于分析。包括 9 项观察性研究和 16 份病例报告（58 例抗 NMDAR-IgG+/MOG-IgG+，21.0 [8.5, 29.0] 岁，男性 58.6%）。血清MOG-IgG+和CSF抗-NMDAR-IgG+患者抗NMDAR-IgG+/MOG-IgG+的发生率（95%CI）分别为0.09（0.02-0.19）和0.07（0.01-0.19），分别。CSF 抗 NMDAR 抗体效价的中位数 [IQR] 为 32 [10, 100]，血清抗 MOG 抗体效价为 100 [32, 320]。突出的临床症状是脑炎表现，包括癫痫（56.9%）和异常行为（51.7%），而不是脱髓鞘表现，如言语障碍（34.5%）和视神经炎（27.6%）。63.4% 的抗 NMDAR-IgG+/MOG-IgG+ 患者出现复发，其中 50.0% 的病例以脑炎表现复发，53.8% 以脱髓鞘表现复发。常见的 MRI 变化发生在皮质或皮质下层 (70.7%) 和脑干 (31.0%)。31.3% 的患者表现为单侧大脑皮质脑炎伴癫痫，12.5% 表现为双侧额叶皮质脑炎。抗 NMDAR-IgG+/MOG-IgG+ 患者表现出更频繁的精神行为 (OR, 95%CI, 68.38, 1.36-3,434.37)、不自主运动 (57.86, 2.53-1,325.11)、睡眠障碍 (195.00, 7.07-15,3)、8与抗 NMDAR-IgG-/MOG-IgG+ 患者相比，软脑膜病变 (7.32, 1.81-29.58) 和较少见的视神经炎 (0.27, 0.09-0.83) 和在感染前出现更常见的复发 (5.63, 1.75-18.09) (2.69, 1.03-7.02), 皮层下病变 (116.60, 4.89-2,782.09), 基底节病变 (68.14, 2.99-1,554.27), 脑干病变 (24.09, 1.01-574.18.18.18.18.18.18.19-574) 脊髓病变与抗 NMDAR-IgG+/MOG-IgG- 相比。综上所述，抗NMDAR-IgG+/MOG-IgG+很少见，但复发率很高。整体症状似乎与 NMDAR 脑炎相似。37)、不自主运动 (57.86, 2.53-1,325.11)、睡眠障碍 (195.00, 7.07-5,380.15) 和软脑膜病变 (7.32, 1.81-29.58)，以及较不常见的视神经炎 (0.809) 与抗-视神经炎 (0.809) 相比 (0.809) NMDAR-IgG-/MOG-IgG+ 患者并呈现更常见的复发 (5.63, 1.75-18.09)、感染前 (2.69, 1.03-7.02)、皮层下病变 (116.60、4.89-2,782.09)、基底节病变 (62.19. 1,554.27)、脑干病变 (24.09、1.01-574.81) 和脊髓病变 (24.09、1.01-574.81) 与抗 NMDAR-IgG+/MOG-IgG- 相比。综上所述，抗NMDAR-IgG+/MOG-IgG+很少见，但复发率很高。整体症状似乎与 NMDAR 脑炎相似。37)、不自主运动 (57.86, 2.53-1,325.11)、睡眠障碍 (195.00, 7.07-5,380.15) 和软脑膜病变 (7.32, 1.81-29.58)，以及较不常见的视神经炎 (0.809) 与抗-视神经炎 (0.809) 相比 (0.809) NMDAR-IgG-/MOG-IgG+ 患者并呈现更常见的复发 (5.63, 1.75-18.09)、感染前 (2.69, 1.03-7.02)、皮层下病变 (116.60、4.89-2,782.09)、基底节病变 (62.19. 1,554.27)、脑干病变 (24.09、1.01-574.81) 和脊髓病变 (24.09、1.01-574.81) 与抗 NMDAR-IgG+/MOG-IgG- 相比。综上所述，抗NMDAR-IgG+/MOG-IgG+很少见，但复发率很高。整体症状似乎与 NMDAR 脑炎相似。与抗 NMDAR-IgG-/MOG-IgG+ 患者相比，视神经炎发生率较低 (0.27, 0.09-0.83)，并且出现更常见的复发 (5.63, 1.75-18.09)、感染前 (2.69, 1.03-7.02)、皮层下病变(116.60, 4.89-2,782.09)、基底节病变 (68.14, 2.99-1,554.27)、脑干病变 (24.09, 1.01-574.81) 和脊髓病变 (24.09, 1.081-G7-MG7-IgG) 与抗-IgG7-IgG 相比IgG-。综上所述，抗NMDAR-IgG+/MOG-IgG+很少见，但复发率很高。整体症状似乎与 NMDAR 脑炎相似。与抗 NMDAR-IgG-/MOG-IgG+ 患者相比，视神经炎发生率较低 (0.27, 0.09-0.83)，并且出现更常见的复发 (5.63, 1.75-18.09)、感染前 (2.69, 1.03-7.02)、皮层下病变(116.60, 4.89-2,782.09)、基底节病变 (68.14, 2.99-1,554.27)、脑干病变 (24.09, 1.01-574.81) 和脊髓病变 (24.09, 1.081-G7-MG7-IgG) 与抗-IgG7-IgG 相比IgG-。综上所述，抗NMDAR-IgG+/MOG-IgG+很少见，但复发率很高。整体症状似乎与 NMDAR 脑炎相似。554.27)、脑干病变 (24.09, 1.01-574.81) 和脊髓病变 (24.09, 1.01-574.81) 与抗 NMDAR-IgG+/MOG-IgG- 相比。综上所述，抗NMDAR-IgG+/MOG-IgG+很少见，但复发率很高。整体症状似乎与 NMDAR 脑炎相似。554.27)、脑干病变 (24.09、1.01-574.81) 和脊髓病变 (24.09、1.01-574.81) 与抗 NMDAR-IgG+/MOG-IgG- 相比。综上所述，抗NMDAR-IgG+/MOG-IgG+很少见，但复发率很高。整体症状似乎与 NMDAR 脑炎相似。