视神经脊髓炎谱系疾病自身抗体分布及相关临床特点研究  

The Distribution of Autoantibodies and Clinical Characteristics in Neuromyelitis Optica Spectrum Diseases

作　　者：邵春青[1] 冯子仪 刘竞争[1] 马瑞敏[1] 王毅娟[1] 卜颖[1] 张国军[1] SHAO Chunqing;FENG Ziyi;LIU Jingzheng;MA Ruimin;WANG Yijuan;BU Ying;ZHANG Guojun(Department of Clinical Laboratory, Beijing Tiantan Hospital, Capital Medical University,Beijing EngineeringResearch Center of Immunological Reagents Clinical Research, Beijing 100070, China;Department of Clinical Laboratory Diagnosis,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京天坛医院检验科北京市免疫试剂临床工程技术研究中心,北京100070 [2]首都医科大学临床检验诊断学系,北京100070

出　　处：《标记免疫分析与临床》2021年第5期729-732,778,共5页Labeled Immunoassays and Clinical Medicine

基　　金：北京市科技计划(编号:Z201100009319005)。

摘　　要：目的探讨视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)患者自身抗体分布,并对比分析伴或不伴自身抗体阳性的临床特征。方法回顾性分析68例NMOSD患者自身免疫相关抗体阳性情况,包括抗核抗体(antinuclear antibody,ANA)荧光检查,抗核抗体谱(ANA谱)15项,抗甲状腺球蛋白抗体(anti-thyroglobulin antibody,aTGAb)、抗甲状腺过氧化物酶抗体(anti-thyroid peroxidase antibody,aTPOAb)。根据是否伴有自身抗体分为自身抗体阳性组和自身抗体阴性组,比较两组患者首次发病年龄、发病次数、性别占比、病程、水通道蛋白-4(aquaporin-4,AQP4)-IgG阳性率及共病情况。结果68例NMOSD患者中,自身抗体阳性37例(54.4%),其中单抗核抗体阳性17例(25.0%),单甲状腺抗体阳性9例(13.2%),抗核抗体和甲状腺抗体同时阳性11例(16.2%)。阳性率较高的自身抗体有ANA 23例(33.8%),抗Ro-52抗体19例(27.9%),aTPOAb 17例(25.0%),抗SSA抗体16例(23.5%)和aTGAb 15例(22.1%),并存在多种自身抗体共存的情况。自身抗体阳性组和阴性组比较,两组在首次发病年龄、发作次数、病程、性别占比及AQP4-IgG阳性率方面差异均无统计学意义(P>0.05);而自身抗体阳性组的其他自身免疫性疾病(如系统性红斑狼疮、类风湿性关节炎、干燥综合征、自身免疫性甲状腺炎等)患病率显著高于自身抗体阴性组(P<0.05)。结论NMOSD患者自身抗体阳性率和自身免疫性疾病的患病率均较高,自身抗体阳性的NMOSD患者更易患其他自身免疫性疾病。自身抗体在NMOSD患者临床特征中的价值有待进一步研究。Objective To investigate the distribution of autoantibodies in patients with neuromyelitis optica spectrum disorders(NMOSD),and to compare the clinical features with or without autoantibodies.Methods A retrospective study was conducted on 68 NMOSD patients.The data included antinuclear antibody(ANA),antinuclear antibody spectrum(ANAs),anti-thyroglobulin antibody(aTGAb)and anti-thyroid peroxidase antibody(aTPOAb).According to the presence of autoantibodies,the patients were divided into the autoantibody-positive group and the autoantibody-negative group.The age of first onset,number of attacks,gender,course of disease,positive rate of Aquaporin-4(AQP4)-IgG and comorbidities of the two groups were compared.Results Among 68 patients with NMOSD,37 cases(54.4%)were positive for autoantibodies,17 cases(25.0%)were positive for ANA or ANAs,9 cases(13.2%)were positive for anti-thyroid antibodies,and 11 cases(16.2%)were positive for both ANA(ANAs)and anti-thyroid antibodies.There were 23 cases of ANA(33.8%),19 cases of anti-RO-52 antibody(27.9%),17 cases of aTPOAb(25.0%),16 cases of anti-SSA antibody(23.5%)and 15 cases of aTGAb(22.1%)with high positive rates,and the coexistence of multiple autoantibodies existed among patients.There were no significant differences in age of first onset,number of attacks,course of disease,gender and positive rate of AQP4-IgG between the two groups(P>0.05).The prevalence of other autoimmune diseases(such as systemic lupus erythematosus,rheumatoid arthritis,Sjogren’s syndrome,autoimmune thyroiditis and so on)in the autoantibody-positive group were significantly higher than those in the autoantibody-negative group(P<0.05).Conclusion The positive rate of autoantibodies and the prevalence of autoimmune diseases are high in NMOSD patients,and NMOSD patients with autoantibodies are more likely to suffer from other autoimmune diseases.The value of autoantibodies in the clinical characteristics of patients with NMOSD needs more further studies.

关 键 词：视神经脊髓炎谱系疾病 水通道蛋白-4 自身抗体 抗核抗体 自身免疫性疾病 

分 类 号：R744.6[医药卫生—神经病学与精神病学]