初步探讨抗AQP4-抗体特异性及视神经脊髓炎谱系疾病与结核性脑膜炎的相关性  

Anti-AQP4-ab specificity and the association of neuromyelitis optica spectrum disorders with tuberculous meningitis analyses

作　　者：刘彩云[1] 朱明勤[1] 冯丽娜 祝捷[1,3] 韩利军[2] LIU Caiyun;ZHU Mingqin;FENG Lina(Department of Neurology and Neuroscience Center,The First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学白求恩第一医院神经内科与神经科学中心,吉林长春130021 [2]长春市传染病医院,吉林长春130062 [3]瑞典卡罗林斯卡医学院神经生物学、保健科学和社会学系,瑞典斯德哥尔摩14157

出　　处：《中风与神经疾病杂志》2018年第8期703-705,共3页Journal of Apoplexy and Nervous Diseases

基　　金：中国国家自然科学基金青年项目(No.31600820);瑞典国家自然科学基金(Diarienummer:2015-03005)

摘　　要：目的探讨诊断视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)的抗水通道蛋白4抗体(anti-aquaporin-4 antibody,anti-AQP4-Ab)的特异性及与结核性脑膜炎(tuberculous meningitis,TBM)是否相关联。方法本研究纳入了30例TBM患者、87例NMOSD患者以及30例正常人,采用细胞转染免疫荧光法(cell based transfection immunofluorescence assay,CBA)检测各组患者血清中抗AQP4-Ab的表达情况,同时对TBM组和NMOSD组患者的临床资料进行回顾性分析寻找两种疾病之间可能存在的关联。结果 TBM组及正常对照组血清中抗AQP4-Ab均为阴性,而NMOSD组抗AQP4-Ab阳性者55例(63. 2%)。TBM组患者出现颅内压升高、脑脊液(cerebral spinal fluid,CSF)外观呈黄色,蛋白和细胞数升高、糖和氯含量下降、并伴有红细胞沉降率(Erythrocyte Sedimentation Rate,ESR)增快等,实验室检查异常情况明显高于NMOSD组,差异有统计学意义(P <0. 05)。结论本研究结果显示TBM患者血清中未检测到抗AQP4-Ab,进一步支持抗AQP4-Ab对诊断NMOSD的特异性,也未发现TBM与NMOSD之间确切的相关性,对于抗AQP4-Ab阴性的与结核病相关长节段横贯性脊髓炎(longitudinally extensive transverse myelitis,LETM)或视力改变是否应该诊断为NMOSD值得进一步探讨。鉴于抗结核药物的毒副作用较大,临床上在没有结核分枝杆菌感染证据的支持下应用抗结核治疗应慎重。Objective To investigate the specificity of anti-aquaporin-4 antibody(anti-AQP4-Ab)in the diagnosis of neuromyelitis optica spectrum disorders(NMOSD),and to analyze the association between NMOSD and tuberculous meningitis(TBM).Methods Thirty TBM patients,eighty-seven NMOSD patients and thirty healthy individuals were enrolled in our study.Cell based transfection immunofluorescence assay(CBA)was used to detect anti-AQP4-Ab in serum of all groups.The clinical data of the NMOSD and TBM patients were collected and analyzed the possible association between these two diseases.Results Serum anti-AQP4-Ab was negative in all the TBM patients and healthy controls,however anti-AQP4-Ab positive was found in 55 NMOSD patients(63.2%).Compared with NMOSD patients,high intracranial pressure,yellow cerebral spinal fluid(CSF),elevated protein and white blood cell(WBC),decreased glucose and chloride in CSF,and elevated erythrocyte sedimentation rate(ESR)were more frequently observed in TBM patients.These differences were statistically significant(P<0.05).Conclusion Our results suggest that anti-AQP4-Ab was not detected in serum of TBM patients,which might further demonstrate the specificity of anti-AQP4-Ab in NMOSD.Thus,we could not confirm the association between TBM and NMOSD suggested.Whether patients with tuberculosis infection concurrent with longitudinally extensive transverse myelitis(LETM)or optic neuritis(ON)with anti-AQP4-Ab negative can be diagnosed as NMOSD is an open question to further discuss.Considering the side effects of anti-tuberculosis drugs,applying such drugs in clinical practice without definite evidence of mycobacterium tuberculosis infections should be carefully evaluated.

关 键 词：视神经脊髓炎谱系疾病 结核性脑膜炎 抗水通道蛋白4抗体 

分 类 号：R744.52[医药卫生—神经病学与精神病学]