水通道蛋白4和髓鞘少突胶质细胞糖蛋白抗体阳性患者临床分析  

A clinical analysis of patients with AQP4-IgG and MOG-IgG seropositive

作　　者：康新梅 孙晓渤[1] 李静[1] 陈晨[1] 卢婷婷[1] 舒崖清[1] 杨晖[2] 王展航 李小晶 胡学强[1] 陆正齐[1] 邱伟[1] 彭立胜 KANG Xinmei;SUN Xiaobo;LI Jing;CHEN Chen;LU Tingting;SHU Yaqing;YANG Hui;WANG Zhanhang;LI Xiaojing;HU Xueqiang;LU Zhengqi;QIU Wei;PENG Lisheng(Department of Neurology,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院神经内科,广州510630 [2]中山大学中山眼科中心 [3]广东三九脑科医院神经内科 [4]广州妇女儿童医疗中心神经内科

出　　处：《中国神经精神疾病杂志》2018年第1期26-31,共6页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的分析中枢神经系统自身免疫相关性疾病患者中血清水通道蛋白4抗体(aquporin 4 antibody,AQP4-Ig G)和髓鞘少突胶质细胞糖蛋白抗体(myelin oligodendrocytes glycoprotein antibody,MOG-Ig G)阳性患者比例;研究两组患者流行病学、临床表现及诊断、实验室检查和MRI影像,为临床诊断及鉴别诊断提供指导。方法纳入中山大学附属第三医院神经科及广州地区多个医疗中心收集的2068例患者。通过细胞间接免疫荧光法对患者血清AQP4-Ig G和MOG-Ig G检测,同时收集并分析比较两组抗体阳性患者临床资料。结果共检出AQP4-Ig G阳性患者681例,男女比例1:9.5,平均发病年龄为(41.7±14.9)岁;MOG-Ig G阳性患者110例,男女比例1:1.08,平均发病年龄为(27.0±17.7)岁,两组间性别分布及发病年龄差异有统计学意义。AQP4-Ig G阳性患者首发症状中视神经炎占38.4%;MOG-Ig G阳性患者中,视神经炎占53.5%。两组间临床表现差异有统计学意义。AQP4-Ig G阳性患者最终诊断为视神经脊髓炎(neuromyelitis optica,NMO)占42.14%;MOG-Ig G阳性患者最终诊断NMO占13.64%,两组间差异存在统计学意义。脑脊液实验室检查显示,两组之间存在差异但差异均无统计学意义。MRI影像学显示,AQP4-Ig G阳性患者多以颈胸髓病灶多见,而MOG-Ig G阳性患者多累及胸腰髓。两组患者可合并其他自身免疫抗体阳性。结论本项研究发现AQP4-Ig G阳性与MOG-Ig G阳性患者在流行病学、临床表现及诊断、实验室检查和MRI影像存在差异,提示AQP4-Ig G阳性和MOG-Ig G两种自身免疫性抗体的检测对于诊断及鉴别诊断有重要意义。Objective To study the seropositive ratio of the antibody to aquporin 4(AQP4-IgG)and myelin oligodendrocytes glycoprotein antibody(MOG-IgG)in patients with autoimmune-associated central nervous system(CNS)diseases.Meanwhile,epidemiology and clinical manifestation and diagnosis,laboratory examination and magnetic resonance imaging(MRI)of AQP4-IgG seropositive and MOG-IgG seropositive patients are described.Methods 2068 patients serum samples were collected and enrolled in the multi-center research.The methodology of cell-mediated immunofluorescence staining was used to detect serum AQP4-IgG and MOG-IgG.Clinic medical records were collected and characteristics of epidemiology and manifestation were compared.Results 681 patients were AQP4-IgG seropositive and 110 patients were MOG-IgG seropositive.The female/male ratio and age of onset of patients with AQP4-IgG seropositive(616 female and 65 male,female:male=9.50:1.00;Age of onset=41.7±14.9)were significantly higher than that of patients with MOG-IgG(57 female and 53 male,female:male=1.08:1.00,P<0.0001;Age of onset=27.0±17.7,P<0.0001).The optic neuritis was significantly higher in patients with AQP4-IgG seropositive and patients with MOG-IgG seropositive(38.4%vs.53.5%,P<0.05).Among patients with AQP4-IgG seropositive,42.14%conformed the diagnostic criteria of neuromyelitis optica(NMO),which was higher than that of patients with MOG-IgG seropositive(13.64%,P<0.0001).Laboratory examination showed that there was no significant difference in cerebrospinal fluid protein levels between patients with AQP4-IgG seropositive and those with MOG-IgG seropositive.MRI imaging suggested that AQP4-IgG positive patients were more common in cervical thoracic spinal cord lesions,while MOG-IgG positive patients were more involved in thoracolumbar spinal cord.The study also found that these two groups of patients could be comorbid with other autoimmune antibodies.Conclusions This multi-center research has revealed that patients with AQP4-IgG seropositive and those with MOG-IgG sero

关 键 词：水通道蛋白4 髓鞘少突胶质细胞糖蛋白抗体 视神经脊髓炎谱系疾病 

分 类 号：R744.52[医药卫生—神经病学与精神病学]