视神经脊髓炎谱系疾病患者血脑屏障通透性与肢体伤残的相关性分析  

Correlation between blood-brain barrier permeability and physical disability in patients with neuromyelitis optica spectrum disorders

作　　者：黄欣欣 丁婕[2] 韩露 于鹭 朱德生[2] 管阳太[1,2] HUANG Xin-xin1, DING Jie2, HAN Lu2, YU Lu1, ZHU De-sheng2, GUAN Yang-tai1, 2(1. Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China; 2. Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, Chin)

机构地区：[1]第二军医大学附属长海医院神经内科,上海200433 [2]上海交通大学医学院附属仁济医院神经内科,上海200127

出　　处：《上海交通大学学报（医学版）》2018年第5期520-523,共4页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金(81471219);上海交通大学医学院转化医学协同创新合作研究项目(TM201508;TM201706)~~

摘　　要：目的·探讨视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)患者血脑屏障(blood-brain barrier,BBB)通透性与肢体伤残的关系及其临床意义。方法·回顾性分析2009年6月—2016年6月第二军医大学附属长海医院与上海交通大学医学院附属仁济医院神经内科确诊的105例NMOSD患者临床资料。根据出院与入院时扩展残疾状况评分量表(expanded disability status scale,EDSS)评分差值将患者分为残疾状况减轻组与加重组,并比较2组患者间的临床特征;分析BBB通透性与肢体伤残之间的相关性。结果·残疾状况减轻组与残疾状况加重组NMOSD患者在性别、年龄、病程、诱发因素、临床症状与治疗用药方面差异无统计学意义(均P>0.05),临床检查中胸髓异常率差异有统计学意义(P=0.023)。2组患者生化资料差异无统计学意义(均P>0.05),脑脊液检查中脑脊液白蛋白/血清白蛋白(cerebrospinal/serum albumin ratio,QALB)偏高率差异有统计学意义(P=0.042)。QALB正常组与偏高组患者残疾状况加重发生人数百分比分别为27.60%(16/58)与46.80%(22/47)(χ~2=4.150,P=0.042)。BBB通透性与肢体伤残发生呈正相关(r=0.299,P=0.042)。结论·NMOSD患者入院时BBB通透性越高,肢体残疾程度越高。BBB通透性差异为探讨NMOSD患者肢体伤残发生的免疫机制提供重要线索。Objective To explore association between blood-brain barrier（BBB） permeability and physical disability in patients with neuromyelitis optica spectrum disorders（NMOSD）. Methods Clinical data of 105 patients with NMOSD was retrospectively analyzed in Department of Neurology at Changhai Hospital, Second Military Medical University and Renji Hospital, Shanghai Jiao Tong University School of Medicine from June 2009 to June 2016. According to the difference between the expanded disability status scale（EDSS） scores when discharged from hospital and when admitted to hospital, NMOSD patients were divided into disability-reduction group and disability-exacerbation group, and their clinical characteristics were compared between the two groups, then association between BBB permeability and physical disability was analyzed. Results Between the disabilityreduction group and the disability-exacerbation group, there was no significant difference in gender, age, disease duration, inducing factor, clinical symptoms, and medication（all P〉0.05）, and the abnormal rates of thoracic spinal cord in clinical examination were statistically different（P=0.023）. There was no significant difference in biochemical data between the two groups（P〉0.05）, and a statistically significant difference was observed in the rate of cerebrospinal/serum albumin ratio（QALB） in the cerebrospinal fluid examination（P=0.042）. The percentages of exacerbation of disability in the QALB normal and high groups were 27.60%（16/58） and 46.80%（22/47）, respectively, and there was a statistically significant difference between the two groups（χ~2=4.150, P=0.042）. BBB permeability was positively correlated with physical disability（r=0.299, P=0.042）. Conclusion The higher the BBB permeability of NMOSD patients on admission is, the higher the degree of physical disability is. The difference in BBB permeability provides key clues to the investigation of the immunological mechanisms of physical disability in NMOSD patients.

关 键 词：神经免疫 视神经脊髓炎谱系疾病 血脑屏障通透性 肢体伤残 

分 类 号：R742[医药卫生—神经病学与精神病学]