水通道蛋白4抗体阳性与阴性视神经脊髓炎谱系疾病影像特征的比较研究  

Comparative study on radiological features between serum aquaporin 4 antibody positive and negative neuromyelitis optica spectrum disorder

作　　者：蒙茗 孙君 孙佳丽 张程祎 田德财 段云云 Meng Ming;Sun Jun;Sun Jiali;Zhang Chengyi;Tian Decai;Duan Yunyun(Department of Radiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院放射科,北京100070 [2]首都医科大学附属北京天坛医院神经病学中心,北京100070

出　　处：《中华放射学杂志》2023年第6期625-631,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(81801199)。

摘　　要：目的探讨血清水通道蛋白4(AQP4)抗体阳性与AQP4抗体阴性视神经脊髓炎谱系疾病(NMOSD)患者的临床、影像学差异。方法回顾性分析2018年1月至2022年6月在首都医科大学附属北京天坛医院确诊的89例NMOSD患者的临床及影像资料,其中男17例,女72例,年龄18~74岁。根据血清AQP4抗体检测结果分为AQP4抗体阳性组与AQP4抗体阴性组,采用独立样本t检验、χ^(2)检验比较2组患者临床资料、病灶分布、病灶特点、脑区体积等方面的差异,并采用Spearman相关性分析进一步探讨脑区体积与扩展残疾状态量表(EDSS)评分之间的相关性。结果AQP4抗体阳性组68例、AQP4抗体阴性组21例。2组患者均以女性多见,但AQP4抗体阳性组中女性占比(86.8%,59/68)高于AQP4抗体阴性组(61.9%,13/21),差异有统计学意义(χ^(2)=4.91,P=0.027)。AQP4抗体阴性组视神经炎的比例(66.7%,14/21)高于AQP4抗体阳性组(41.2%,28/68),差异有统计学意义(χ^(2)=4.18,P=0.041)。在MRI颅内病灶的分布中,AQP4抗体阴性组病灶累及脑干的概率(47.6%,10/21)高于AQP4抗体阳性组(23.5%,16/68),差异有统计学意义(χ^(2)=4.50,P=0.034)。AQP4抗体阳性组的全脑白质体积、右侧杏仁核、右侧伏隔核及右侧腹侧间脑的体积均低于AQP4抗体阴性组(P<0.05);并且右侧伏隔核的体积与AQP4抗体阳性组的EDSS评分呈负相关(r=-0.628,P=0.009)。结论AQP4抗体阳性组与AQP4抗体阴性组患者临床和影像学表现存在差异,这为临床深入认识NMOSD提供更多依据。Objective To investigate the clinical and imaging differences between serum aquaporin 4(AQP4)antibody positive and negative patients with neuromyelitis optica spectrum disorder(NMOSD).Methods The clinical data and radiologic findings of 89 NMOSD patients diagnosed at Beijing Tiantan Hospital,Capital Medical University from January 2018 to June 2022 were retrospectively analyzed.There were 17 male cases and 72 female cases,aged 18-74 years.According to the results of serum AQP4 antibody test,the patients were divided into AQP4 antibody positive group and AQP4 antibody negative group,and the differences in clinical data,lesion distribution,lesion characteristics,and brain area volume between the 2 groups were compared using independent sample t-test andχ^(2) test,and the correlation between brain area volume and expanded disability status scale(EDSS)scores was further investigated using Spearman correlation analysis.Results There were 68 cases in the AQP4 antibody positive group and 21 cases in the AQP4 antibody negative group.Patients in both groups were predominantly female,but the percentage of females in the AQP4 antibody-positive group(86.8%,59/68)was higher than that in the AQP4 antibody-negative group(61.9%,13/21),with a statistically significant difference(χ^(2)=4.91,P=0.027).The incidence of optic neuritis in AQP4 antibody negative group(66.7%,14/21)was higher than that in antibody positive group(41.2%,28/68),with a statistically significant difference(χ^(2)=4.18,P=0.041).In the distribution of intracranial lesions on MRI,the probability of lesions involving the brain stem in AQP4 antibody negative group(47.6%,10/21)was higher than that in AQP4 antibody positive group(23.5%,16/68),the difference had statistically significance(χ^(2)=4.50,P=0.034).The volumes of whole brain white matter,right amygdala,right accumbens-area and right ventral diencephalon in AQP4 antibody positive group were lower than those in AQP4 antibody negative group(P<0.05),and the volumes of the right accumbens-area were negatively

关 键 词：视神经脊髓炎 磁共振成像 水通道蛋白4抗体 脑体积 

分 类 号：R744.52[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]