抗髓鞘少突胶质细胞糖蛋白抗体合并抗N-甲基-D-天冬氨酸受体抗体阳性患者临床特点分析  

Analysis of clinical characteristics of patients with anti-myelin oligodendrocyte glycoprotein and anti-N-methyl-D-aspartate receptor antibody positive

作　　者：沈敏慧 俞海 刘小妮 杨文波 张祥 李亚蓉 张晓玲 陈向军 Shen Minhui;Yu Hai;Liu Xiaoni;Yang Wenbo;Zhang Xiang;Li Yarong;Zhang Xiaoling;Chen Xiangjun(Department of Neurology,Huashan Hospital,Department of Neuroimmunology,Institute of Neurology,Fudan University,Shanghai 200040,China;Department of Neurology,Jiaxing Second Hospital,Jiaxing,Zhejiang 314001,China)

机构地区：[1]复旦大学附属华山医院神经内科,神经病学研究所神经免疫室,上海200040 [2]嘉兴市第二医院神经内科,314001

出　　处：《中华神经科杂志》2021年第9期898-907,共10页Chinese Journal of Neurology

基　　金：上海申康医院发展中心临床三年行动计划(SHDC2020CR2027B)。

摘　　要：目的分析抗髓鞘少突胶质细胞糖蛋白(MOG)抗体合并抗N-甲基-D-天冬氨酸受体(NMDAR)抗体双阳性患者的临床特点,提高临床医生对此类疾病的认识,并为其诊断提供参考。方法回顾性分析2017年3月至2020年3月于复旦大学附属华山医院神经内科住院的血清抗MOG抗体和脑脊液抗NMDAR抗体均阳性的18例患者(双抗体阳性组),并利用SPSS软件进行简单随机抽样,随机选取同期就诊的血清抗MOG抗体单阳性的20例患者(抗MOG组)和脑脊液抗NMDAR抗体单阳性的20例患者(抗NMDAR组)进行组间比较。收集并分析3组患者的临床特征、检查结果及预后差异。结果3组患者人口学资料差异无统计学意义(均P>0.05),双抗体阳性组患者的症状通过聚类分析分为两类症状群,分别与抗MOG组和抗NMDAR组聚类分析后得到的症状群相对应,通过对应分析再次验证亦然。双抗体阳性组与抗MOG组相比,癫痫发作(8/18比3/20,P=0.016)、精神行为异常(8/18比0/20,P=0.001)、视力障碍(8/18比17/20,P=0.016)、构音障碍/吞咽障碍(8/18比1/20,P=0.007)的发生率差异有统计学意义。双抗体阳性组与抗NMDAR组相比,精神行为异常(8/18比19/20,P=0.001)、共济失调(12/18比1/20,P<0.001)的发生率差异有统计学意义。组间两两比较,甲状腺过氧化物酶抗体合并率、甲状腺球蛋白抗体合并率、抗核抗体合并率、脑脊液压力、脑脊液白细胞计数、蛋白、氯化物、葡萄糖水平、寡克隆区带阳性率差异均无统计学意义(均P>0.017;应用Bonferroni校正进行多组间两两比较,以P<0.017为差异有统计学意义)。双抗体阳性组与抗NMDAR组相比,头颅磁共振成像有无病灶差异有统计学意义(18/18比8/20,P<0.001)。双抗体阳性组、抗MOG组和抗NMDAR组患者治疗前初始改良Rankin量表(mRS)评分差异有统计学意义[分别为(3.72±0.96)分、(2.75±0.97)分和(3.95±0.76)分,F=10.004,P<0.001],治疗后6个月mRS评分差异无统计学Objective To analyze the clinical characteristics of patients with double-positive anti-myelin oligodendrocyte glycoprotein(MOG)antibody and anti-N-methyl-D-aspartate receptor(NMDAR)antibody,so as to raise awareness of such diseases and improve the prognosis.Methods Eighteen patients(double positive group)with positive serum anti-MOG antibody and cerebrospinal fluid anti-NMDAR antibody in Huashan Hospital,Fudan University from March 2017 to March 2020 were retrospectively analyzed.Using the SPSS software for simple random sampling,anti-MOG group(20 cases)and anti-NMDAR group(20 cases)were randomly selected at the same time for comparison.The anti-MOG group referred to the patients only with positive serum anti-MOG antibody.While the anti-NMDAR group referred to the patients whose cerebrospinal fluid anti-NMDAR antibody was positive.The clinical characteristics,laboratory examination results,radiological characteristics and prognosis of the three groups were collected and analyzed.Results There was no statistically significant difference in demographic data among the three groups(P>0.05).The symptoms of patients in the double-positive group were divided into two categories by cluster analysis,which corresponded to the symptom groups obtained by cluster analysis of the anti-MOG group and the anti-NMDAR group,and the same result was verified by correspondence analysis.Compared with the anti-MOG group,the incidence of epilepsy(10/18 vs 3/20,P=0.016),psychosis and behavior change(8/18 vs 0/20,P=0.001),visual disturbances(8/18 vs 17/20,P=0.016),dysarthria/dysphagia(8/18 vs 1/20,P=0.007)was significantly different in the double-positive group(P<0.017).Compared with the anti-NMDAR group,the incidence of ataxia(8/18 vs 19/20,P=0.001),psychosis and behavior change(12/18 vs 1/20,P<0.001)was significantly different in the double-positive group.There was no statistically significant difference in the combination rate of thyroid peroxidase antibody,thyroglobulin antibody and antinuclear antibody between two groups,and the cere

关 键 词：受体 N-甲基-D-天冬氨酸 髓鞘少突胶质细胞糖蛋白 抗体 重叠综合征 免疫治疗 

分 类 号：R742.9[医药卫生—神经病学与精神病学]