中枢神经系统脱髓鞘疾病短期预后不良的自身免疫相关危险因素分析  

Analysis of autoimmune related risk factors for poor short-term prognosis in patients with demyelinating disease of central nervous system

作　　者：王宁宁 冯宁 赵顺锋 赵鑫 赵龙飞 蒋事和 苌浩晓 朱晓冬[1] Wang Ningning;Feng Ning;Zhao Shunfeng;Zhao Xin;Zhao Longfei;Jiang Shihe;Chang Haoxiao;Zhu Xiaodong(Department of Neurology,General Hospital of Tianjin Medical University,Tianjin 300041,China;Department of Clinical Laboratory,Third People′s Hospital of Liaocheng,Liaocheng 252000,China;China National Clinical Research Center for Neurological Diseases,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]天津医科大学总医院神经内科,天津300041 [2]聊城市第三人民医院检验科,聊城252000 [3]首都医科大学附属北京天坛医院、国家神经系统疾病临床医学研究中心,北京100050

出　　处：《中国医师进修杂志》2023年第11期1041-1046,共6页Chinese Journal of Postgraduates of Medicine

基　　金：国家自然科学基金(81971094);天津市科技计划项目(22YDTPJC00350)。

摘　　要：目的分析影响中枢神经系统脱髓鞘疾病短期预后的免疫学相关危险因素,并评估其预测价值。方法回顾性分析2012年1月至2022年10月首都医科大学附属北京天坛医院和天津医科大学总医院362例中枢神经系统脱髓鞘疾病患者的临床资料,包括视神经脊髓炎谱系疾病(NMOSD)181例,多发性硬化(MS)129例,抗髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)38例,急性播散性脑脊髓炎(ADEM)14例。根据出院时临床扩展致残量表(EDSS)评分将患者分为预后良好组(EDSS≤3分,267例)和预后不良组(EDSS>3分,95例),比较两组患者的临床资料、入院病情严重程度(入院EDSS评分)、治疗、自身抗体情况及免疫球蛋白水平、血清炎性因子水平。采用多因素Logistic回归模型分析影响中枢神经系统脱髓鞘疾病患者短期预后的独立危险因素;采用受试者工作特征(ROC)曲线评估相关危险因素的预测效能。结果与预后良好组相比,预后不良组入院EDSS评分更高[2.5(1.5)分比6.5(3.5)分],自身免疫病相关抗体、系统性自身抗体、抗核抗体、抗可提取核抗原抗体、甲状腺过氧化物酶抗体和甲状腺球蛋白抗体阳性率更高[89.5%(85/95)比59.6%(159/267)、75.8%(72/95)比52.1%(139/267)、65.3%(62/95)比38.6%(103/267)、42.1%(40/95)比23.2%(62/267)、40.0%(38/95)比19.1%(51/267)和42.1%(40/95)比19.9%(53/267)],血清IgM明显降低[0.84(0.78)g/L比1.00(0.75)g/L],血清肿瘤坏死因子-α和白细胞介素-2受体及脑脊液IgG明显升高[8055(3118)pg/L比6830(3515)pg/L、348(175)kU/L比314(146)kU/L、47.50(46.50)g/L比33.00(24.00)g/L],差异有统计学意义(P<0.01或<0.05)。多因素Logistic回归分析结果显示,入院EDSS评分和抗核抗体阳性是影响中枢神经系统脱髓鞘疾病患者短期预后不良的独立危险因素(OR=5.034和6.942,95%CI 3.289~7.705和2.250~21.422,P<0.01)。ROC曲线分析结果显示,抗核抗体阳性联合入院EDSS评分预测中枢神经系统脱髓鞘疾�Objective To analyze the immunology-related risk factors for short-term prognosis in patients with demyelinating diseases of central nervous system,and to evaluate their predictive value.Methods From January 2012 to October 2022 in Beijing Tiantan Hospital of Capital Medical University and General Hospital of Tianjin Medical University,the clinical data of 362 patients with demyelinating diseases of central nervous system were analyzed,including neuromyelitis optic spectrum disease(NMOSD)181 cases,multiple sclerosis(MS)129 cases,anti-myelin oligodendrocyte glycoprotein antibody associated disease(MOGAD)38 cases,acute disseminated encephalomyelopathy(ADEM)14 cases.According to the expanded disability status scale(EDSS)score at discharge,the patients were divided into good prognosis group(EDSS≤3 scores,267 cases)and poor prognosis group(EDSS>3 scores,95 cases).The clinical data,admission severity(admission EDSS score),treatment,autoantibodies and immunoglobulin level and serum inflammatory factor level were compared between two groups.Multivariate Logistic regression was used to analyze the independent risk factors of short-term prognosis in patients with demyelinating diseases of central nervous system;and the predictive efficacy was evaluated by receiver operating characteristic(ROC)curve.Results Compared with the good prognosis group,the admission EDSS score in the poor prognosis group was significantly higher:2.5(1.5)scores vs.6.5(3.5)scores.The positive rates of autoimmune disease-related antibody,systemic autoantibody,anti-nuclear antibody,anti-extractable nuclear antigen antibody,thyroid peroxidase antibody and thyroid globulin antibody were significantly higher:89.5%(85/95)vs.59.6%(159/267),75.8%(72/95)vs.52.1%(139/267),65.3%(62/95)vs.38.6%(103/267),42.1%(40/95)vs.23.2%(62/267),40.0%(38/95)vs.19.1%(51/267)and 42.1%(40/95)vs.19.9%(53/267).The serum IgM was significantly lower:0.84(0.78)g/L vs.1.00(0.75)g/L.The serum tumor necrosis factor-α,interleukin-2 receptor and cerebrospinal fluid IgG were significan

关 键 词：脱髓鞘自身免疫疾病 中枢神经 预后 危险因素 

分 类 号：R744.5[医药卫生—神经病学与精神病学]