水通道蛋白4抗体阳性视神经脊髓炎谱系疾病相关性视神经炎患者临床特征及预后因素分析  

Analysis of clinical features and prognostic factors of aquaporin 4 antibody positive neuromyelitis optica spectrum disorders related optic neuritis

作　　者：徐歆桐 杨沫[2] 周欢粉[2] 孙明明 魏世辉[2] Xu Xintong;Yang Mo;Zhou Huanfen;Sun Mingming;Wei Shihui(Chinese PLA Medical School,Beijing 100853,China;Department of Ophthalmology,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心眼科,北京100853

出　　处：《中华眼底病杂志》2022年第12期968-973,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：国际科技创新合作重点专项(2018YFE0113900);国家自然科学基金(面上项目)(81870662)。

摘　　要：目的观察并分析水通道蛋白4(AQP4)抗体阳性视神经脊髓炎谱系疾病相关性视神经炎(NMOSD-ON)患者临床特征及预后相关因素。方法双向队列研究。2015年6月1日至2019年6月1日于解放军总医院第一医学中心神经眼科病区检查确诊的AQP4抗体阳性NMOSD-ON患者103例纳入研究。所有患者随访时间≥24个月。根据末次随访时最佳矫正视力(BCVA),将患眼分为低视力组[最小分辨角对数(logMAR)BCVA≥1.0]、非低视力组(logMAR BCVA<1.0),分别为66、37例。对比观察两组患者临床特征并采用logistic回归模型和COX比例风险模型分析影响患者视力预后及复发的相关因素。结果103例中,女性96例(93.2%,96/103);单眼94例(91.3%,94/103)。首次发病48例(46.6%,48/103)。发病时伴眼痛或眼眶痛85例(82.5%,85/103);视盘水肿21例(20.4%,21/103)。血清自身免疫抗体阳性51例(49.5%,51/103)。行眼眶核磁共振成像(MRI)检查101例,视路未见明显异常信号5例(5.0%,5/101);可见视路异常信号96例(95.0%,96/101),其中视神经眶内段异常52例(51.5%,52/101)。24个月内复发37例(35.9%,37/103)。低视力组、非低视力组患者首次发病后恢复的BCVA以及随访6个月时、末次随访时logMAR BCVA分别为1.4±1.0、0.3±0.4、1.9±0.7和0.4±0.5、2.1±0.6、0.3±0.4;两组患者不同时间logMAR BCVA比较,差异均有统计学意义(Z=-4.967、-7.603、-8.027,P<0.001)。Logistic回归分析结果显示,首次发病后恢复的logMAR BCVA≥1.0[比值比(OR)=226.276,P<0.001]和发作次数越多(OR=8.554,P=0.003)是影响视力预后的不利因素。COX比例风险模型多因素分析结果显示,MRI评分越高[风险比(HR)=0.588,P=0.007]和急性期血浆置换治疗(HR=0.124,P=0.049)是防止疾病复发的有利因素。结论AQP4抗体阳性NMOSD-ON患者视力下降伴眼痛或眼眶痛是发病时主要症状,少数患者伴视盘水肿;49.5%的患者自身免疫抗体阳性;95.0%的患者眼眶MRI可见视路异常信号,其中51.5%的�Objective To analyze the clinical features and prognosis factors of aquaporin 4(AQP4)antibody-positive neuromyelitis optica spectrum disorders related optic neuritis(NMOSD-ON).Methods An ambidirectional cohort study.From June 1,2015 to June 1,2019,103 patients with AQP4 antibody-positive NMOSD-ON in Department of Neuro-ophthalmology,The First Medical Center of PLA General Hospital were included.All patients of followed-up period were≥24 months.According to the best corrected visual acuity(BCVA)at the last follow-up,the affected eyes were divided into the low vision group[log of minimum resolution angle(logMAR)BCVA≥1.0]and the non-low vision group(logMAR BCVA<1.0),66 and 37 cases,respectively.The two groups of patients were compared the genernal clinical characteristics,and the logistic regression model and COX proportional hazard model were used to analyze the relevant factors affecting the patient's visual prognosis and recurrence.Results Among the 103 cases,96 cases(93.2%,96/103)were female;94 cases(91.3%,94/103)had unilateral disease;48 cases(46.6%,48/103)were the first onset;85 cases(82.5%,85/103)were effected by eye pain or orbital pain;21 cases(20.4%,21/103)had optic disc edema;51 cases(49.5%,51/103)serologically autoimmune antibody test were positive.Orbital magnetic resonance imaging(MRI)was performed in 101 cases.There was no obvious abnormal signal in visual pathways except for 5 cases(5.0%,5/101);96 cases(95.0%,96/101)had abnormal signal in the visual path,and the optic nerve was found in the orbit;52 cases had abnormal optic nerve in orbital segment(51.5%,52/101);37 cases(35.9%,37/103)recurred within 24 months.The recovery of logMAR BCVA after the first onset and the logMAR BCVA at the first onset,at 6 months of follow-up in two groups were 1.4±1.0,0.3±0.4,1.9±0.7 and 0.4±0.5,2.1±0.6,0.3±0.4,respectively;and there were statistically significant differences between the two groups of patients at different times(Z=-4.967,-7.603,-8.027;P<0.001).Logistic regression multivariate analysis showed th

关 键 词：视神经炎 水通道蛋白质4 预后 复发 影响因素分析 

分 类 号：R744.52[医药卫生—神经病学与精神病学] R774.6[医药卫生—临床医学]