中国西部地区脱髓鞘性视神经炎患者AQP4-IgG表达及其临床特征关系分析  

Analysis of the relationship between AQP4-IgG expression and clinical characteristics in patients with demyelinated optic neuritis in western China

作　　者：王晓蕾 王贞 李小梅 龚春蓓 刘勇 屈娅 Wang Xiaolei;Wang Zhen;Li Xiaomei;Gong Chunbei;Liu Yong;Qu Ya(Department of Ophthalmology,The First Affiliated Hospital of Army Medical University,Key Lab of Visual Damage and Regeneration&Restoration of Chongqing)

机构地区：[1]陆军军医大学第一附属医院眼科、视觉损伤与再生修复重庆市重点实验室,重庆400038

出　　处：《重庆医科大学学报》2022年第8期970-976,共7页Journal of Chongqing Medical University

基　　金：军队医学科技青年培育计划拔尖资助项目(编号:20QNPY027);陆军军医大学第一附属医院课题资助项目(编号:SWHLJS-202006)。

摘　　要：目的:比较142例脱髓鞘性视神经炎(demyelinated optic neuritis,DON)患者血清或脑脊液中AQP4-IgG表达与其临床特征的关系。方法:回顾性收集2016年1月至2020年10月于陆军军医大学第一附属医院眼科收治的142例DON患者AQP4-IgG检验结果,对AQP4-IgG阳性及阴性患者的临床资料进行分析。结果:①检测到AQP4-IgG阳性者48例(33.8%),女性与男性比为5.9∶1,双眼同时发病者31例(64.6%),发病时LogMAR视力为0.48±0.64,随访结束时LogMAR视力为0.55±0.65。②检测到AQP4-IgG阴性者94例(66.2%),女性与男性比为1.7∶1,双眼同时发病者53例(56.4%),发病时LogMAR视力为0.54±0.61,随访结束时LogMAR视力为0.39±0.49。③AQP4-IgG阳性女性患者比例明显高于AQP4-IgG阴性患者(χ^(2)=7.827,P<0.01);二者双眼患病率不具有统计学差异(χ^(2)=0.884,P>0.05);二者在发病时LogMAR视力并无统计学差异(t=-0.721,P>0.05),但AQP4-IgG阳性患者视力预后更差(t=2.058,P<0.05)。AQP4-IgG阳性患者血沉升高(χ^(2)=5.403,P<0.05),以及合并自身抗体结果阳性的比例比AQP4-IgG阴性患者更高(χ^(2)=5.231,P<0.05),二者均具有统计学差异。结论:AQP4-IgG阳性的视神经脊髓炎谱系疾病患者女性发病率更高,视力预后更差,且可能合并自身抗体结果异常或者自身免疫性疾病。根据AQP4-IgG检测结果,准确地进行临床分型对治疗方案选择及预后分析具有重要指导意义。Objective:To compare the relationship between AQP4-IgG expression and its clinical characteristics in the serum or cere⁃brospinal fluid of 142 patients with demyelinated optic neuritis(DON).Methods:We retrospectively collected and analyzed the clini⁃cal data and AQP4-IgG results of 142 DON patients admitted to the Department of Ophthalmology of The First Affiliated Hospital of Army Medical University from January 2016 to October 2020.Results:①AQP4-IgG positive was detected in 48 cases(33.8%),the fe⁃male to male ratio was 5.9∶1,and 31 cases(64.6%)involved both eyes.The LogMAR visual acuity at the first visit was 0.48±0.64,and was 0.55±0.65 at the last visit.②AQP4-IgG negative was detected in 94 cases(66.2%),the female to male ratio was 1.7∶1,and 53 cases(56.4%)involved both eyes.The LogMAR visual acuity at the first visit was 0.54±0.61,and was 0.39±0.49 at the last visit.③The proportion of AQP4-IgG-positive female patients was significantly higher than that of AQP4-IgG-negative patients(χ^(2)=7.827,P<0.01);there was no statistical difference in the prevalence of both eyes(χ^(2)=0.884,P>0.05);there was no significant difference in Log⁃MAR visual acuity at the time of onset(t=-0.721,P>0.05),but AQP4-IgG positive patients had worse visual prognosis(t=2.058,P<0.05).AQP4-IgG positive patients had higher erythrocyte sedimen⁃tation rate(χ^(2)=5.403,P<0.05)and a higher proportion of combined autoantibody results than AQP4-IgG negative patients(χ^(2)=5.231,P<0.05),both of which had significant differences.Conclusion:AQP4-IgG-positive patients with neuromyelitis optica spectrum disorders have a higher incidence of female morbidity,with worse visual prognosis,and may be combined with abnormal autoantibody results or autoimmune diseases.Accurate clinical classification based on AQP4-IgG detection is important for the treatment and prognosis.

关 键 词：脱髓鞘性视神经炎 水通道蛋白抗体 视神经脊髓炎谱系疾病 基于细胞底物检测法 自身免疫性疾病 

分 类 号：R774.6[医药卫生—眼科]