MOG抗体阳性视神经脊髓炎谱系疾病临床和影像学特点  

The clinical and radiological features of MOG antibody positive demyelinating diseases of central nervous system

作　　者：姚海燕[1,2] 黄清梅 邱伟[3] 徐辉明 刘天妮 杨华才 陈百铿 刘思 高聪[1,2] 龙友明[1,2] YAO Haiyan;HUANG Qingmei;QIU Wei;XU Huiming;LIU Tianni;YANG Huacai;CHEN Baikeng;LIU Si;GAO Cong;LONG Youming(Department of Neurology,The Second Affiliated Hospital of GuangZhou Medical University,250# Changgang East Road,GuangZhou 510260,China;Institute of Neuroscience and the Second Affiliated Hospital of GuangZhou Medical University,250# Changgang East Road,GuangZhou 510260,China)

机构地区：[1]广州医科大学附属第二医院神经内科,广州510260 [2]广州医科大学附属第二医院神经科学研究所 [3]中山大学附属第三医院神经内科

出　　处：《中国神经精神疾病杂志》2018年第11期646-650,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：广东省科技计划项目(编号:2015A030302093)

摘　　要：目的探讨血清髓鞘少突胶质细胞糖蛋白(myelin oligodendrocyte glycoprotein, MOG)抗体阳性的视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorder, NMOSD)患者的临床和影像学特点。方法收集NMOSD患者57例、多发性硬化(multiple sclerosis, MS)患者29例,回顾性分析MOG抗体阳性的NMOSD患者的临床和影像学特点。结果 9/57(15.8%)NMOSD患者血清MOG抗体阳性,其中1例患者血清MOG与水通道蛋白-4(aquaporin-4, AQP4)抗体双阳性,2/29(6.9%)MS患者血清MOG抗体阳性,两组患者MOG抗体阳性率差异无统计学意义(P>0.05)。MOG抗体阳性NMOSD患者男女比例为1:7,平均起病年龄为(41.4±11.5)岁,与MOG抗体阴性组以及AQP4抗体阳性组相比差异无统计学意义(P>0.05)。MOG抗体阳性NMOSD组、MOG抗体阴性NMOSD组的病程均比AQP4抗体阳性NMOSD组短,差异有统计学意义(P均<0.05),但MOG抗体阳性NMOSD组与MOG抗体阴性NMOSD组比较差异无统计学意义(P>0.05)。三组患者均以复发为主,平均复发次数比较差异无统计学意义(P>0.05)。MOG抗体阳性NMOSD患者出现视神经炎比例为62.5%,AQP4抗体阳性组比例为43.5%,两者差异无统计学意义(P>0.05)。三组患者颅内病灶的形态以及部位均无统计学差异(P>0.05)。MOG抗体阳性NMOSD患者多为单发长节段脊髓病灶,脊髓病灶数量比MOG抗体阴性组和AQP4抗体阳性组更少,但三组单个脊髓病灶所对应的中位椎体数相近,差异无统计学意义(P>0.05)。结论 MOG抗体阳性的NMOSD患者女性比例更高,以复发为主,病程较短,易合并视神经炎,影像学表现与AQP4抗体阳性的NMOSD相比无明显特异性。Objective Our study aimed to delineate the clinical and radiological features of patients with anti-myelin oligodendrocyte glycoprotein antibody(MOG-Ab)positive neuromyelitis optica spectrum disorder(NMOSD).Methods Fifty-seven patients with NMOSD and 29 patients with multiple sclerosis(MS)were collected.Data on clinical and radiological features of MOG-Ab positive patients with were analyzed retrospectively.Results MOG-Abs were present in 9/57(15.8%)NMOSD patients and 2/29(6.9%)MS patients.Both MOG and aquaporin-4(AQP4)antibodies were positive in one case of NMOSD.There was no significant difference between the two groups(P>0.05).There were more females than males having MOG-Ab positive NMOSD(females:males=7:1)and the average onset age was 41.4±11.5 years.There was no significant difference in gender and age between MOG-Ab negative and AQP4-Ab positive groups(P>0.05).The durations of disease were significantly shorter in either MOG-Ab positive NMOSD patients or MOG-Ab negative NMOSD patients than in AQP4-Ab positive group(P<0.05).Recurrence was the main disease pattern of all three groups and the frequency of recurrence was not significant different among three groups(P>0.05).The incidence of optic neuritis was 62.5%in NMOSD patients with MOG-Ab positive and 43.5%in AQP4-Ab positive NMOSD patients(P>0.05).There was no significant difference in the morphology and location of brain lesions among the three groups(P>0.05).MOG-Ab positive NMOSD patients had long segment spinal cord lesions.The median length of the spinal cord lesions in the MOG-Ab positive group was similar to the other two groups(P>0.05).Conclusions MOG-Ab positive NMOSD patients have higher proportion of females with shorter recurrence course,more likely complicated with optic neuritis.And the radiological features of brain and spinal cord were not specific to patients with AQP4-Ab positive.

关 键 词：视神经脊髓炎谱系疾病 髓鞘少突胶质细胞糖蛋白 临床特点 磁共振成像 

分 类 号：R744.52[医药卫生—神经病学与精神病学]