水通道蛋白-4抗体阳性患者的诊断  

Retrospective analysis of the diagnosis of patients with positive aquaporin- 4 antibody

作　　者：何毅华[1] 龙友明[1] 杨新光[1] 杨宁[2] 范永祥[1] 殷建瑞[1] 蒲蜀湘[1] 高庆春[1] 高聪[1] 

机构地区：[1]广州医科大学附属第二医院神经内科,广州510260 [2]广州医科大学附属第五医院神经内科,广州510700

出　　处：《广东医学》2014年第16期2495-2497,共3页Guangdong Medical Journal

基　　金：广东省自然科学基金资助项目(编号:S2013010016262);广东省科技计划项目(编号:2012B031800240;2012B061700042)

摘　　要：目的对水通道蛋白-4(AQP4)抗体阳性患者进行重新诊断,并回顾分析患者的以往诊断,从而有助于加强对视神经脊髓炎(NMO)及其谱系疾病(NMOSD)的再认识,指导进一步的诊治。方法 AQP4抗体通过间接免疫荧光的细胞法检测。回顾性分析AQP4抗体阳性患者的不同时期诊断。结果 139例AQP4抗体阳性患者被纳入本研究。首次发作的临床诊断如下:7例(5.0%)NMO,20例(14.4%)多发性硬化(MS),39例(28.1%)视神经炎(ON),59例(42.4%)脊髓炎(TM),其他诊断14例(10.1%)。病程中的修正诊断如下:33例(23.7%)NMO,68例(48.9%)MS,8例(5.8%)ON,28例(20.1%)TM,其他诊断2例(1.4%)。最终诊断如下:88例(63.3%)NMO,51例(36.7%)NMOSD,包括了7例(13.7%,7/51)复发性ON,39例(76.5%,39/51)复发性TM和5例(9.8%,5/51)无ON、TM的NMOSD。最终的88例NMO患者中,52例(59.1%)被误诊为MS。结论AQP4抗体阳性患者常被误诊为MS。Objective To analyze the diagnosis of patients with positive aquaporin -4 （AQP4） antibody, and to re - evaluate the previous diagnosis, thus to provide evidences for diagnosis and treatment for patients with neuromyelitis optica （NMO） and NMO spectrum disorder （NMOSD）. Methods AQP4 antibodies were tested by an indirect immuno- fluorescence assay employing HEK -293 cells transeeted with recombinant human AQP4. Clinical diagnoses were retro- spectively analyzed. Results A total of 139 patients with positive AQP4 antibody were included. In the initial episode, NMO, multiple sclerosis （MS）, optic neuritis （ON）, transverse myelitis （TM） and the other diagnosis were diagnosed in 7 （5%）, 20 （14.4%）, 39 （28.1%）, 59 （42.4%） and 14 （10. 1% ） patients, respectively. In the follow-up, ac- cording to revised diagnosis, NMO, MS, ON, TM and other disorders were diagnosed in 33 （23.7%）, 68 （48. 9% ）, 8 （5.8%）, 28 （20. 1% ） and 2 （1.4%） patients, respectively. The final diagnosis showed that 88 patients diagnosed as NMO and 51 patients as NMOSD, including 7 patients （13.7%） with recurrent ON, 39 patients （76. 5% ） with recurrent TM and 5 patients （9. 8% ） with other lesions in brain. Conclusion Patients with positive AQP4 antibody are usually misdiagnosed as MS.

关 键 词：水通道蛋白-4 视神经脊髓炎 多发性硬化 诊断 

分 类 号：R743.3[医药卫生—神经病学与精神病学]