AQP4-IgG阳性视神经脊髓炎谱系疾病的脑脊液细胞学特点  

The characteristics of the cerebrospinal fluid cytology in AQP4-IgG positive neuromyelitis optica spectrum disorders

作　　者：刘慧勤[1] 任海涛[2] 徐雁[2] 高鑫雅 李玮[1] 张杰文[1] 关鸿志[2] LIU Huiqin;REN Haitao;XU Yan;GAO Xinya;LI Wei;ZHANG Jiewen;GUAN Hongzhi(Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]河南省人民医院神经内科,450003 [2]中国医学科学院北京协和医院神经科,100730

出　　处：《中国神经免疫学和神经病学杂志》2018年第1期6-10,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：河南省科技攻关项目(162102310295)

摘　　要：目的探讨水通道蛋白4抗体(AQP4-IgG)阳性的视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)的脑脊液细胞学特点。方法回顾性收集AQP4-IgG阳性的NMOSD患者的脑脊液细胞学、脑脊液常规、生化及寡克隆区带结果,并分析其特点。结果共收集237例AQP4-IgG阳性的NMOSD患者的脑脊液细胞学资料。女∶男=7.8∶1。120例(50.6%)患者脑脊液细胞学可见炎性反应,炎性反应程度为轻、中、重度者分别为63、43、14例。95例为淋巴细胞性炎性反应,20例为淋巴细胞与中性粒细胞性炎性反应,4例为淋巴细胞与嗜酸性粒细胞性炎性反应,1例为淋巴细胞、中性粒细胞与嗜酸性粒细胞性炎性反应。71例(30.0%)患者可见激活淋巴细胞,11例(4.6%)可见激活单核细胞,15例(6.3%)可见浆细胞。176例患者行寡克隆区带检测,其中脑脊液特异性寡克隆区带阳性47例(26.7%)。结论达1/2的AQP4-IgG阳性NMOSD患者脑脊液细胞学可见炎性反应,以淋巴细胞性炎性反应为主,也可见中性粒细胞与嗜酸性粒细胞参与;部分患者脑脊液细胞学可见激活淋巴细胞、激活单核细胞和浆细胞;AQP4-IgG阳性NMOSD患者脑脊液特异性寡克隆区带阳性率较多发性硬化低。上述脑脊液特点有助于NMOSD的诊断和鉴别。Objective To explore the characteristics of the cerebrospinal fluid(CSF)cytology in AQP4-IgG positive neuromyelitis optica spectrum disorders(NMOSD).Methods We retrospectively collected the CSF results of patients with NMOSD who were serum AQP4-IgG positive,and analyzed the characteristics of the CSF cytology and other CSF results of these patients.Results The CSF cytology data of 237 patients with AQP4-IgG positive NMOSD were collected.Female∶male ratio=7.8∶1.Visible inflammation was seen in 120(50.6%)patients CSF cytology:63 cases with mild inflammatory reaction,43 cases with moderate inflammation and 14 cases with severe inflammation.For inflammation types,95/20/4 cases were classified to lymphocytic inflammation/lymphocytic and neutrophilic inflammation/lymphocytic and eosinophilic inflammation respectively,while only 1 patients was classified to lymphocytic,neutrophilic and eosinophilic inflammation.Activated lymphocytes were seen in 71(30.0%)patients while activated mononuclear cells in 11(4.6%)cases and plasma cells in 15(6.3%)cases.Oligoclonal bands were detected in 176 of all the patients,and the specific oligoclonal band in CSF was positive in 47 cases.The positive rate was 26.7%.Conclusions Inflammatory reaction was observed in about half of the AQP4-Ig G positive NMOSD patients CSF cytology,and the main inflammatory types was lymphocytic inflammation while neutrophils and eosinophils were also seen in a few patients.Activated lymphocytes,activated mononuclear cells,and plasma cells could be detected in some patients CSF.The positive rate of the specific oligoclonal band in AQP4-Ig G positive NMOSD was lower than that in multiple sclerosis.These CSF characteristics may contribute to the diagnosis and antidiastole of NMOSD.

关 键 词：AQP4-IgG 视神经脊髓炎谱系疾病 脱髓鞘疾病 多发性硬化 脑脊液 细胞学 寡克隆区带 水通道蛋白质4 

分 类 号：R742.5[医药卫生—神经病学与精神病学]