视神经脊髓炎谱系疾病的临床特点及复发影响因素分析  

Analysis of clinical characteristics and relapse-affecting factors of neuromyelitis optica spectrum disorders

作　　者：张玉莹 吴鹏 邢俊娥 黄立武 ZHANG Yu-ying;WU Peng;XING Jun-e(Guangxi University of Traditional Chinese Medicine,Nanning 530001,China)

机构地区：[1]广西中医药大学,南宁530001 [2]广西中医药大学第一附属医院

出　　处：《山西中医》2024年第7期51-54,共4页Shanxi Journal of Traditional Chinese Medicine

基　　金：广西壮族自治区自然科学基金面上项目(编号:2020GXNSFAA238032)。

摘　　要：目的:探讨视神经脊髓炎谱系疾病患者的中西医临床特点及复发影响因素。方法:收集51例视神经脊髓炎谱系疾病患者临床资料,回顾性分析其临床特点,将51例患者分为复发组(n=31)和非复发组(n=20),采用Logistic回归分析筛选出视神经脊髓炎谱系疾病复发的相关影响因素。结果:研究对象男女比例为1∶6.29,平均发病年龄(41.80±14.85)岁,平均发病病程[36.00(72.00,7.00)]个月,平均发病(5.06±4.51)次,有明确发病诱因16例,AQP4-IgG阳性39例,视神经、头颅和颈胸髓常受累,合并其他自身免疫性疾病抗体阳性28例,神经电生理检查异常11例,使用免疫抑制剂治疗32例。中医病位多为脾、肝、肾等,病性多为气虚、阴虚、湿、痰、阳虚、瘀、血虚、热,证型多为脾胃气虚、肝肾阴虚、脾肾阳虚、湿热阻滞、气血两虚及气滞血瘀,伴痰湿、痰热、血瘀等。AQP4-IgG阳性、长节段脊髓病灶、其他自身免疫性抗体阳性及未使用免疫抑制剂是视神经脊髓炎谱系疾病复发的危险因素(OR>1,P<0.05)。结论:视神经脊髓炎谱系疾病发病以青壮年女性为主,病程长,AQP4-IgG阳性率高,多累及视神经、头颅和颈胸髓,可合并其他自身免疫性疾病,神经电生理诱发电位多异常。中医病位多涉及脾肝肾,病机以气虚、阴虚为主,多见脾胃气虚、肝肾阴虚等证。Objective:To approach the clinical characteristics of TCM and western medicine of patients with neuromyelitis optica spectrum disorders(NMOSD)and the relapse-affecting factors.Methods:Clinical data of 51 patients with NMOSD were collected,and their clinical characteristics were retrospectively analyzed.51 cases of patients were divided into relapse group(n=31)and non-relapse group(n=20).The relevant factors of affecting NMOSD relapse were screened by Logistic regression analysis.Results:The ratio of male to female of studied subjects was 1:6.29.The average age of onset was(41.80±14.85)years old.The average disease course of onset was[36.00(72.00,7.00)]months.The average incidence rate was(5.06±4.51)times.As regards western medicine:16 cases were with clear induced factors of onset;39 cases were with AQP4 IgG positive;optic nerve,head and cervicothoracic cord were frequently affected;28 cases were with positive antibody complicated with other autoimmune diseases;11 cases were with abnormal neural electrophysiological examinations;32 cases were treated with immunosuppressants.As regards TCM:The lesion location was mainly spleen,liver,kidney,etc.;the nature of disease was mainly deficiency of qi,deficiency of yin,dampness,phlegm,deficiency of yang,blood stasis,deficiency of blood and heat;the syndrome types were mostly deficiency of spleen qi and stomach qi,deficiency of liver-yin and kidney-yin,deficiency of spleen yang and kidney yang,damp-heat obstruction,deficiency of both qi and blood and qi stagnation and blood stasis,and intermingled with phlegm and dampness,phlegm and heat and blood stasis,etc.The risk factors of NMOSD relapse were AQP4-IgG positive,myelopathy of long segment,other positive autoimmune antibodies and no use of immunosuppressants(OR﹥1,P﹤0.05).Conclusion:The onset of NMOSD is mainly in young and middle-aged women,with long disease course and high positive rate of AQP4 IgG.It mostly affects the optic nerve,head and cervicothoracic cord,and may be complicated with other autoimmune diseases.

关 键 词：视神经脊髓炎谱系疾病 临床特点 复发因素 

分 类 号：R744.52[医药卫生—神经病学与精神病学]