中国人视神经脊髓炎谱系疾病及多发性硬化与妊娠的相关性  

Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis Associated with Pregnancy in Chinese

作　　者：黄艳露 黄巧[2] 卢婷婷[1] 许成芳[3] 陆正齐[1] 胡学强[1] 邱伟[1] 

机构地区：[1]中山大学附属第三医院神经科,广东广州510630 [2]肇庆市第二人民医院神经科,广东肇庆526060 [3]中山大学附属第三医院产科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2017年第2期267-272,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81471218);广东省自然科学基金(2014A030313014);广东省科技计划项目(2013B051000037)

摘　　要：【目的】分析国人视神经脊髓炎谱系疾病(NMOSD)和多发性硬化(MS)与妊娠相关性的异同,以及与妊娠的相互作用。【方法】前瞻性收集235例NMOSD和125例MS患者临床资料,包括年复发率(ARR)、病残程度(EDSS)以及妊娠结局等,筛选出目标病例NMOSD组70例和MS组30例,并纳入50例同期正常妊娠妇女作为对照组,比较分析NMOSD、MS患者在妊娠前1年、中、后1年ARR、EDSS评分变化情况,对比分析3组妊娠结局的差异。【结果】NMOSD和MS首发症状出现在妊娠中或分娩/流产1年内的比率分别分53.25%(41/77)和20.00%(7/35),两者之间有显著差异(P=0.001);NMOSD和MS在产后0~3月ARR(2.65,2.51)显著高于妊娠前1年(0.27,0.49,P<0.001)及妊娠中(0.32,0.20,P<0.001),且产后1年EDSS(3.06±2.16,2.19±1.28)显著高于妊娠前1年(1.58±0.48,1.92±1.29,P<0.001)及妊娠中(1.92±1.35,1.67±0.70,P<0.001),但NMOSD和MS两组之间ARR及EDSS评分无差异;NMOSD、MS与正常对照组妊娠结局及新生儿体质量无差异。【结论】与MS相比,NMOSD发病与妊娠相关性更加显著;NMOSD和MS患者分娩及流产均可能增加疾病复发风险并加重疾病残疾,而疾病本身不影响妊娠结局。【Objective】To compare the differences of neuromyelitis optica spectrum disorder（NMOSD）and multiple sclerosis（MS）on pregnancy,and analyze the mutual impact of pregnancy on the diseases.【Methods】 Prospectively collected clinical information of 235 NMOSD patients and 125 MS patients,including the annualized relapse rate（ARR）,the Expanded Disability Status Scale（EDSS）and pregnancy outcomes.70 NMOSD patients and 30 MS patients were screened out as information patients.The ARR and EDSS score in two groups were compared during the year before pregnancy,during pregnancy and after 1 year postpartum,respectively.50 cases of normal pregnant women for the same period as the control group,then to compared the difference of three groups on pregnancy outcomes.【Results】Attacks occurring during pregnancy or one year after childbirth/abortion in NMOSD and MS were 53.25%（41/77）and 20.00%（7/35）（P = 0.001）;The ARR during the first 3 months postpartum periods of NMOSD and MS group（2.65,2.51）was significantly higher than during the year before pregnancy（0.27,0.49,P〈0.001）and during pregnancy（0.32,0.2,P〈0.001）;The EDSS score of two groups increased after 1 year postpartum（3.06 ± 2.16,2.19 ± 1.28）than that during the year before pregnancy（1.58 ± 0.48,1.92 ± 1.29,P〈0.001）and during pregnancy（1.92 ± 1.35,1.67 ± 0.70,P〈0.001）.There was no difference on ARR and EDSS score between NMOSD and MS group.NMOSD,MS and normal control group had no difference on pregnancy outcomes and neonatal weight.【Conclusions】Compared with MS,the attack of NMOSD had more closer relationship with pregnancy;both NMOSD and MS would increase the risk of disease relapsing and disability after pregnancy;the diseases had no effect on pregnancy outcomes.

关 键 词：视神经脊髓炎谱系疾病 多发性硬化 妊娠 相关性 

分 类 号：R71[医药卫生—妇产科学]