AQP4-IgG阳性与AQP4-IgG阴性NMOSD的临床学比较研究  

Clinical comparative study of AQP4-IgG positive and AQP4-IgG negative NMOSD

作　　者：武国良 彭涛[1] WU Guoliang;PENG Tao(Department of Neurology,the First Affiliated Hospital of Zhengzhou University,Henan,Zhengzhou 450052,China)

机构地区：[1]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》2021年第3期217-222,共6页Journal of Apoplexy and Nervous Diseases

摘　　要：目的比较AQP4-IgG阳性与AQP4-IgG阴性视神经脊髓炎谱系疾病(NMOSD)患者的临床学特点。方法收集2015年9月至2019年9月在郑州大学第一附属医院住院的345例NMOSD患者的临床资料,根据AQP4-IgG血清学状态,将NMOSD患者分为AQP4-IgG阳性组与AQP4-IgG阴性组。结果AQP4-IgG阳性组与阴性组分别有244例和101例,AQP4-IgG阳性组的女性发病率、抗核抗体谱阳性率及其他自身免疫性疾病的共患率明显高于阴性组(P=0.000;P=0.000;P=0.003),AQP4-IgG阴性组的脑部病变、视神经炎及既有视神经炎又有脊髓炎的发病率明显高于阳性组(P=0.000;P=0.000;P=0.012),AQP4-IgG阳性组的免疫抑制剂使用率高于阴性组(P=0.025)。此外,AQP4-IgG阳性组的维生素B12、血沉均高于阴性组(P=0.015;P=0.009),AQP4-IgG阴性组的同型半胱氨酸、血红蛋白明显高于阳性组(P=0.001;P=0.002);脊髓炎发病率、脊髓病变节段数、腰髓病变、幕上病变、复发率、疾病发作次数、随访时间、最低点及最后1次随访EDSS在AQP4-IgG阳性组与阴性组间均无统计学差异(均P>0.05),年龄、C反应蛋白、白细胞、血小板、脑脊液中的白细胞、淋巴细胞比率及蛋白定性在两组间亦无统计学差异(均P>0.05)。结论AQP4-IgG阳性与阴性NMOSD患者在临床特征方面确实存在很多差异。与AQP4-IgG阳性组相比,阴性组更常见视神经炎、脑部病变及视神经和脊髓同时受累,其血红蛋白及同型半胱氨酸明显更高;阳性组的女性、抗核抗体谱及共患其他自身免疫性疾病更常见,其维生素B12及血沉更高。Objective To compare the clinical characteristics of AQP4-IgG-positive and AQP4-IgG-negative optic neuromyelitis spectrum disease(NMOSD)patients.Methods Clinical data of 345 NMOSD patients admitted to the First Affiliated Hospital of Zhengzhou University from September 2015 to September 2019 were collected.According to the serological status of AQP4-IgG,NMOSD patients were divided into AQP4-IgG positive group and AQP4-IgG negative group.Results There were 244 cases in the AQP4-IgG positive group and 101 cases in the AQP4-IgG negative group,respectively.The female,anti-nuclear antibody spectrum and other autoimmune diseases in the AQP4-IgG positive group were significantly higher than those in the negative group(P=0.000;P=0.000;P=0.003),the incidence of brain lesions,optic neuritis,both optic neuritis and myelitis in AQP4-IgG negative group were significantly higher than those in the positive group(P=0.000;P=0.000;P=0.012);The utilization of immunosuppressive agents in the AQP4-IgG positive group was significantly higher than that in the negative group(P=0.025).In addition,vitamin B12 and ESR were significantly higher in the AQP4-IgG positive group than in the negative group(P=0.015;P=0.009);The homocysteine and hemoglobin in AQP4-IgG negative group were significantly higher than those in the positive group(P=0.009;P=0.002).The incidence of myelitis,the segments of myelopathy,lumbar spinal lesions,supratententinal lesions,the total number of attacks,follow-up time,the lowest and the last follow-up EDSS showed no statistical difference between AQP4-IgG positive group and negative group(P>0.05),there were no statistically differences in age,C-reactive protein,leukocyte,platelet,the ratio of white blood cell and lymphocyte,protein in CSF between the two groups(P>0.05).Conclusion There are many differences in clinical disease characteristics between AQP4-IgG positive and negative NMOSD patients.Optic neuritis,brain lesions and simultaneous involvement of optic nerve and spinal cord were more common in AQP4-IgG negativ

关 键 词：AQP4-IgG 视神经脊髓炎谱系疾病 抗核抗体谱 同型半胱氨酸 

分 类 号：R744.52[医药卫生—神经病学与精神病学]