血清水通道蛋白4抗体测定对视神经脊髓炎的诊断及预后判断价值  

Diagnostic and prognostic value of serum AQP4 antibody on neuromyelitis optica

作　　者：厉向[1] 童巧文[2] 柯建明[1] 叶莉萍[3] 戚飞腾[1] 万真[1] 夏君慧[1] 

机构地区：[1]温州医科大学附属第一医院神经内科,浙江温州325000 [2]温州医科大学第三临床学院神经内科,浙江温州325000 [3]烟台市毓璜顶医院重症监护室,山东烟台264000

出　　处：《中国病理生理杂志》2014年第11期1974-1979,共6页Chinese Journal of Pathophysiology

基　　金：温州市科技局项目(No.Y20100234)

摘　　要：目的:探讨血清水通道蛋白4(AQP4)抗体检测对视神经脊髓炎(NMO)诊断及预后判断的临床价值。方法:收集2010年1月至2013年12月在温州医科大学附属第一医院神经内科住院或门诊就诊的48例NMO、33例脊髓炎(TM)[包括26例长节段脊髓炎(LETM)和7例复发性脊髓炎(r LETM)]、30例视神经炎(ON)[包括25例双眼视神经炎(BON)和5例复发性视神经炎(RION)]、52例多发性硬化(MS)及16例其它神经系统疾病(OND)的患者血清及相关临床资料。采用细胞免疫荧光法检测血清AQP4抗体。分析各组患者血清AQP4抗体的阳性率及抗体滴度,比较AQP4抗体阳性NMO患者与AQP4抗体阴性患者的临床特征。通过绘制受试者工作特征曲线(ROC曲线),评价AQP4对NMO诊断的敏感性和特异性。应用Kaplan-Meier曲线分析血清AQP4抗体阳性患者进展为NMO的累计概率。结果:NMO组AQP4抗体阳性率最高(87.50%),其后依次为r LETM组(85.71%)、RION组(80.00%)、LETM组(30.70%)、BON组(8.00%)和MS组(3.85%),OND组抗体检测为阴性。NMO组中血清AQP4抗体阳性患者在性别构成比、确诊为NMO时间及伴有严重神经炎的比例等方面,与抗体阴性患者相比差异有统计学意义(P<0.05)。ROC曲线提示血清AQP4抗体对诊断NMO的敏感性为87.5%,特异性为85.4%。KaplanMeier曲线提示AQP4抗体阳性患者进展为NMO的累积概率明显高于抗体阴性的患者(P<0.05)。结论:血清AQP4抗体检测对诊断NMO具有较高的敏感性及特异性,且有助于NMO预后和转归的判断。AIM： To investigate the diagnostic and prognostic value of the serum AQP4 antibody on neuromyelitis optica（ NMO）. METHODS： Sera of the patients with NMO,transverse myelitis（ TM）,optic neuritis（ ON）,multiple sclerosis（ MS） and other neurological disease（ OND） were all collected and detected for the presence of AQP4 antibody by CBA. The positive rates and the titers of AQP4 antibody were compared among all the groups. The characteristics of NMO patients with AQP4 antibody positive and those AQP4 antibody negative were also compared. The sensitivity and specificity of serum AQP4 antibody for diagnosis of NMO were evaluated with receiver operating characteristic（ ROC） curve. The KaplanMeier curve was used to examine the accumulated rate of AQP4 antibody for the progress to NMO. RESULTS： The AQP4 antibody positive rate in NMO group was the highest（ 87. 50%）. Orderly,r LETM group was 85. 71%,RION group was80. 00%,LETM group was 30. 70%,BON group was 8. 00%,and MS group was 3. 85%. The AQP4 antibody was negative in OND group. There was significant difference between AQP4 antibody positive and AQP4 antibody negative NMO patients on gender,the number of patients with poor visual outcome,time of NMO diagnose confirmed（ P〈0. 05）. The sensitivity and specificity were 87. 5% and 85. 4% for discriminating NMO from other diseases. The Kaplan-Meier curve showed that AQP4-Ab-positive patients were more likely to become NMO compared to the AQP4-Ab-negative patients. CONCLUSION：The serum AQP4 antibody is extensively important in the early diagnosis and prognosis of the NMO with high sensitivity and high specificity.

关 键 词：视神经脊髓炎 水通道蛋白4抗体 多发性硬化 

分 类 号：R446.62[医药卫生—诊断学]