肝、肾功能及免疫相关指标在视神经脊髓炎谱系疾病诊断中的应用价值  

Application value of liver,renal function and autoantibody-related indexes in the diagnosis of neuromyelitis optica spectrum disorder

作　　者：刘亚楠[1,2] 姜文灿 陈柯霖 邵春青[1,2,3] 刘雪松 张国军[1,2,3] LIU Yanan;JIANG Wencan;CHEN Kelin;SHAO Chunqing;LIU Xuesong;ZHANG Guojun(Department of Clinical Diagnosis,Laboratory of Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;National Engineering Research Center for Beijing Biochip Technology,Beijing 100070,China;NMPA Key Laboratory for Quality Control for In Vitro Diagnostic,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院实验诊断中心,北京100070 [2]北京市免疫试剂临床工程技术研究中心,北京100070 [3]国家药监局体外诊断试剂质量控制重点实验室,北京100070

出　　处：《国际检验医学杂志》2024年第18期2189-2196,共8页International Journal of Laboratory Medicine

基　　金：北京市高层次公共卫生技术人才建设项目培养计划(2022-2-013)、北京市科学技术协会青年人才托举工程(BYESS2022170)、北京市医院管理中心登峰计划(DFL20220505)。

摘　　要：目的分析肝功能、肾功能、自身抗体指标在神经脊髓炎谱系疾病(NMOSD)患者中的分布特点及其诊断价值。方法回顾性收集2015年6月至2023年6月在首都医科大学附属北京天坛医院确诊为NMOSD、多发性硬化(MS)患者,以及性别、年龄匹配的常规体检健康者肝功能、肾功能和自身抗体检测数据。共纳入95例NMOSD患者(NMOSD组)、230例MS患者(MS组)、244例常规体检健康者(常规体检组),评估各指标对NMOSD的诊断价值。结果与MS组相比,NMOSD组丙氨酸氨基转移酶、α-羟基丁酸脱氢酶、γ-谷氨酰基转移酶水平,以及抗SS-A抗体、抗SS-B抗体、抗核糖体P蛋白抗体和Ro-52抗体阳性率等明显升高,白蛋白、间接胆红素、总胆红素水平明显降低,差异均有统计学意义(P<0.05)。NMOSD组与常规体检组差异指标与MS组相似。α-羟丁酸脱氢酶、白蛋白、球蛋白、直接胆红素、间接胆红素、总胆汁酸和尿酸碱度7项指标均可用于NMOSD诊断,联合诊断的曲线下面积为0.969,灵敏度和特异度为92.6%和92.9%。结论NMOSD患者多种肝、肾功能指标与MS和常规体检健康者存在差异,NMOSD患者部分自身抗体指标阳性率高于MS患者,临床可将肝、肾功能及自身抗体指标用于辅助诊断,并且多指标联合应用可进一步提升其诊断价值。Objective To analyze the distribution characteristics and application value of liver,renal function indexes and autoantibody-related indexes of neuromyelitis optica spectrum disorder(NMOSD).Methods The liver,renal function and autoantibody-related indexes data of patients diagnosed with NMOSD and multiple sclerosis(MS)in Beijing Tiantan Hospita,Capital Medical University from June 2015 to June 2023,as well as gender and age-matched controls underwent routine physical examination were retrospectively collected.A total of 95 patients with NMOSD(NMOSD group),230 patients with MS(MS group),and 244 healthy controls(routine physical examination group)were selected to evaluate the diagnostic value of each index for NMOSD.Results Compared with MS group,the levels of alanine aminotransferase,as well as the positive rates ofα-hydroxybutyrate dehydrogenase,γ-glutamyltransferase,anti-SS-A antibody,anti-SS-B antibody,anti-ribosomal P protein antibody and Ro-52 antibody were significantly increased in NMOSD group,while the levels of albumin,indirect bilirubin and total bilirubin were significantly decreased,and the differences were statistically significant(P<0.05).The difference index between NMOSD and conventional physical examination group was similar to that of MS group.The seven indexes,α-hydroxybutyrate dehydrogenase,albumin,globulin,direct bilirubin,indirect bilirubin,total bile acid and uric acid alkalinity could be used for the diagnosis of NMOSD.The area under the curve of combined diagnosis of NMOSD was 0.969,and the sensitivity and specificity were 92.6%and 92.9%.Conclusion Multiple indexes of liver and kidney function in NMOSD patients are different from those in MS patients and healthy subjects underwent routine physical examination,and the positive rate of some autoantibody indexes in NMOSD patients is higher than that in MS patients.Liver,renal function and autoantibody-related indexes can be used clinically to assist diagnosis,and the combined application of multiple indexes can further enhance its diagnost

关 键 词：视神经脊髓炎谱系疾病 肝功能指标 肾功能指标 自身抗体指标 

分 类 号：R446.1[医药卫生—诊断学] R744.52[医药卫生—临床医学]