免疫抑制剂治疗抗水通道蛋白4抗体阳性视神经脊髓炎谱系疾病患者复发风险分析  

Relapse risk analysis in anti-aquaporin 4-IgG positive neuromyelitis optica spectrum disorders patients treated with immunosuppressant

作　　者：尹翮翔[1] 张遥[1] 王文君 徐雁[1] 彭斌[1] 崔丽英 Yin Hexiang;Zhang Yao;Wang Wenjun;Xu Yan;Peng Bin;Cui Liying(Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Neurosciences Center,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院神经科,北京100730 [2]中国医学科学院北京协和医院神经科中国医学科学院神经科学中心,北京100730

出　　处：《中华神经科杂志》2022年第4期306-311,共6页Chinese Journal of Neurology

摘　　要：目的:探讨免疫抑制剂治疗抗水通道蛋白4抗体(AQP4-IgG)阳性视神经脊髓炎谱系疾病(NMOSD)患者复发危险因素。方法:收集2011年1月至2021年6月北京协和医院多发性硬化及相关疾病患者数据登记系统中使用免疫抑制剂治疗5年及以上的AQP4-IgG阳性NMOSD患者资料,分析治疗期间有复发患者和无复发患者的临床特点和复发因素差异。结果:共纳入AQP4-IgG阳性NMOSD患者112例,其中女性105例(93.8%);发病年龄(34.9±11.3)岁;发病年龄≥50岁(晚发型)患者13例(11.6%);病程为8.1(6.6,11.4)年。64例(57.1%)患者出现复发。与无复发组相比,复发组中晚发型患者比例较低[分别为4/64(6.3%)和9/48(18.8%),χ2=4.18, P=0.041]。复发组治疗前年复发率[分别为1.07(0.36,2.25)次/年和0.34(0,1.11)次/年, Z=2.92, P=0.003]、复发患者比例[分别为54/64(84.4%)和33/48(68.8%),χ2=3.86, P=0.049]均显著高于无复发组。多因素Logistic回归分析结果表明晚发型患者相较于早发型患者复发风险下降( HR=0.26,95% CI 0.10~0.73, P=0.010),治疗前年复发率高者治疗期间的复发风险显著升高( HR=1.55,95% CI 1.26~1.91, P<0.001)。 结论:发病年龄<50岁或开始治疗前复发频繁的AQP4-IgG阳性NMOSD患者接受传统免疫抑制剂治疗后的复发风险较高,可能需要启动高效治疗。Objective To investigate the relapse risk factors of anti-aquaporin 4(AQP4)-IgG positive neuromyelitis optica spectrum disorders(NMOSD)patients treated with immunosuppressant.Methods Data(from January 2011 to June 2021)of AQP4-IgG positive NMOSD patients treated with immunosuppressant for longer than 5 years from MSNMObase,a hospital-based electronic registry for multiple sclerosis and related disorders in Peking Union Medical College Hospital,were collected.Clinical features and risk factor differences between patients with and without relapse under the immunosuppressive therapy were analyzed.Results One hundred and twelve patients with AQP4-IgG positive NMOSD were included,105(93.8%)of which were female.The disease onset age was(34.9±11.3)years,13(11.6%)had an older disease onset age than 50 years(late onset),and the disease duration was 8.1(6.6,11.4)years.Sixty-four(57.1%)patients had relapse,and the proportion of late onset patients was significantly lower in relapse group than in non-relapse group[4/64(6.3%)vs 9/48(18.8%),χ²=4.18,P=0.041].Compared with those without relapse,both the annualized relapse rate(ARR)before treatment[1.07(0.36,2.25)vs 0.34(0,1.11),Z=2.92,P=0.003]and the proportion of patients with relapse before treatment[54/64(84.4%)vs 33/48(68.8%),χ²=3.86,P=0.049]were significantly higher for patients in relapse group.Multivariate Logistic regression analysis revealed the relapse risk of late-onset patients was lower than that of early-onset patients(HR=0.26,95%CI 0.10-0.73,P=0.010)and patients with higher ARR before treatment showed a higher risk of relapse under the immunosuppressive therapy(HR=1.55,95%CI 1.26-1.91,P<0.001).Conclusion AQP4-IgG positive NMOSD patients with younger disease onset age than 50 years or with frequent relapses before treatment had a higher relapse risk under the immunosuppressive therapy,and they may need highly effective treatments.

关 键 词：视神经脊髓炎 抗水通道蛋白4抗体 免疫抑制剂 复发 治疗应用 

分 类 号：R744.52[医药卫生—神经病学与精神病学]