MOG抗体阳性和AQP4抗体阳性NMOSD患者的临床及影像学分析  

The analysis of clinical and radiological on MOG antibody positive and AQP4 antibody positive NMOSD patients

作　　者：张植 张敏[1] 刘恒方[1] 吴世陶[1] 刘勋 耿明 李聪颖 李元枭 ZHANG Zhi;ZHANG Min;LIU Hengfang(Department of Neurology,The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院神经内科,河南郑州450052 [2]郑州大学第一附属医院神经内科,河南郑州450052

出　　处：《中风与神经疾病杂志》2018年第10期873-876,共4页Journal of Apoplexy and Nervous Diseases

基　　金：河南省科技攻关项目(No.182102310533)

摘　　要：目的比较髓鞘少突胶质细胞糖蛋白抗体(MOG-IgG)阳性和水通道蛋白4抗体(AQP4-IgG)阳性的视神经脊髓炎谱系疾病(NMOSD)患者临床表现和影像学特征,以提高对MOG-IgG阳性NMOSD的认识。方法对12例MOG-IgG阳性、98例AQP4-IgG阳性患者的性别、发病年龄、病程复发、EDSS评分、脑脊液蛋白、视觉诱发电位及磁共振(MRI)表现等进行回顾性分析。结果 MOG-IgG阳性与AQP4-IgG阳性相比,男性多见(χ~2=11. 270,P=0. 001),视神经和脊髓多同时受累(83. 3%),并常累及双侧视神经(χ~2=6. 050,P=0. 014),多呈单次病程(χ~2=11. 270,P=0. 001),表现出更好的预后(t=-4. 673,P=0. 001)。影像学上MOG-IgG组未发现典型的颅内病灶,AQP4-IgG组43例存在典型的颅内病灶(χ~2=8. 645,P=0. 003)。延髓极后区受累MOG-IgG组1例,AQP4-Ig G组37例(χ~2=4. 039,P=0. 043)。MOG-IgG与AQP4-IgG患者累及腰髓分别为6例、8例(χ~2=16. 847,P=0. 001);累及颈髓分别为4例、67例(χ~2=5. 734,P=0. 017)。结论 NMOSD患者中MOG-IgG阳性与AQP4-IgG阳性患者相比男性多见,多累及双侧视神经及腰髓,典型颅内病灶及延髓极后区病灶较少,呈单次病程,预后较好。Objective To compare the clinical and radiological features of myelin oligodendrocyte glycoprotein antibody(MOG-IgG)positive and aquaporin 4 antibody(AQP4-IgG)positive neuromyelitis spectrum disease(NMOSD)patients to improve the understanding of MOG-IgG positive NMOSD patients.Methods 12 cases of MOG-IgG positive,98 cases of AQP4-IgG positive patients were enrolled in this research and their gender,age of onset,duration of recurrence,the EDSS score,cerebrospinal fluid protein,visual evoked potential,imaging findings and other manifestations were analyzed retrospectively.Results Compared with AQP4-IgG positive,MOG-IgG positive was more common in males(χ2=11.270,P=0.001).The optic nerve and spinal cord were affected at the same time(83.3%),and bilateral optic nerves were often involved(χ2=6.050,P=0.014).Most of them presented a single course of disease(χ2=11.270,P=0.001)and showed a better prognosis(t=-4.673,P=0.001).No typical intracranial lesions were found in the MOG-IgG positive group while there were 43 typical intracranial lesions in the AQP4-IgG positive group(χ2=8.645,P=0.003).In the MOG-IgG positive group there was 1 case innvolving the posterior area of the medulla oblongata and 37 cases in the AQP4-IgG positive group(χ2=4.039,P=0.043).The proportion of patients with MOG-IgG positive and AQP4-IgG positive involving the lumbar spinal cord was 6 cases and 8 cases(χ2=16.847,P=0.001),the cervical cord involvement was 4 cases and 67 cases(χ2=5.734,P=0.017).Conclusion In NMOSD patients,compared with patients with AQP4-IgG positive,MOG-IgG positive patients were more common in males,and were more likely to have bilateral optic nerves and lumbar medulla involvement,typical intracranial lesions and medulla oblongata lesions are rare,showed a single course of disease and a better progosis.

关 键 词：视神经脊髓炎谱系疾病 MOG抗体 AQP4抗体 临床 影像学 

分 类 号：R744.52[医药卫生—神经病学与精神病学]