视神经脊髓炎谱系疾病缓解期免疫治疗与复发因素分析  

Analysis of the immunotherapy and relapse factors during the remission phase of neuromyelitis optica spectrum disorders

作　　者：颜榕[1] 崔世磊[1] 郭燕军 王佳伟[1] Rong YAN;Shilei CUI;Yanjun GUO;Jiawei WANG(Department of Neurology,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院神经内科,北京100176

出　　处：《临床药物治疗杂志》2024年第10期21-26,共6页Clinical Medication Journal

基　　金：国家自然科学基金(82271384)。

摘　　要：目的分析视神经脊髓炎谱系疾病(NMOSD)患者缓解期免疫治疗和复发情况,探讨免疫治疗对预防疾病复发的效果以及复发影响因素。方法采用单中心队列回顾性研究方法,收集2017年12月1日至2019年12月1日北京同仁医院神经内科收治的NMOSD及相关疾病患者数据库中NMOSD的连续非重复病例为研究对象,对患者的人口学特征、免疫治疗、扩展残疾状况量表(EDSS)评分、复发情况等进行回顾性分析,随访患者至入组后出现首次临床复发。比较入组后复发和未复发患者的临床特征,采用COX多因素回归分析复发影响因素。结果共收集NMOSD患者161例,男23例(14.3%),女138例(85.7%),非首次发作患者85例(53.1%),中位年复发率为0.85(0.36,2.16)。入组时仅5例(3.1%)患者曾接受预防性免疫治疗,入组后接受预防性免疫治疗患者上升至99例(61.5%),二者比较差异有统计学意义(P<0.05)。共有145例患者完成随访,中位随访时间为718.0(501.5,991.0)d,其中复发患者73例(50.3%)。末次随访时持续预防性免疫治疗患者73例(50.3%),中位治疗时间为998.0(633.5,1937.0)d;缓解期免疫治疗药物排名前3位的依次为吗替麦考酚酯、利妥昔单抗和硫唑嘌呤。末次随访时中位年复发率下降至0.10(0.00,0.71),较基线状态差异有统计学意义(P<0.05)。COX多因素回归分析显示,抗核抗体(ANA)阳性(HR=2.471,95%CI:1.266~4.823)和利妥昔单抗治疗(HR=3.365,95%CI:1.021~11.089)的NMOSD复发风险降低,入组核心症状为非视神经-脊髓型的NMOSD复发风险升高(HR=0.255,95%CI:0.092~0.712)。结论规律预防性免疫治疗可减少NMOSD复发,利妥昔单抗治疗和ANA阳性NMOSD患者复发风险降低;出现非视神经-脊髓型症状说明NMOSD复发风险升高,提示需要更加积极的预防性免疫治疗策略。Objective To analyze the immunotherapy and relapse situation in patients with neuromyelitis optica spectrum disorder(NMOSD)during the remission phase,and to explore the effects of immunotherapy in preventing disease relapses and the factors influencing relapses.Methods A single-center cohort retrospective study was conducted,collecting consecutive non-repeat cases of NMOSD from the database of patients admitted to the Department of Neurology at Beijing Tongren Hospital from December 1,2017,to December 1,2019.Demographic characteristics,immunotherapy,expanded disability status scale(EDSS)scores,and relapse situations were retrospectively analyzed,with follow-up until the first clinical relapse after enrollment.Clinical characteristics of patients who relapsed and those who did not were compared,and the COX multivariate regression analysis was conducted to analyze the factors affecting relapses.Results A total of 161 NMOSD patients were collected,with 23 males(14.3%)and 138 females(85.7%).Among them,85 patients(53.1%)had experienced more than one episode,with a median annualized relapse rate(ARR)of 0.85(0.36,2.16).At enrollment,only 5 patients(3.1%)had received preventive immunotherapy,which increased to 99 patients(61.5%)after enrollment,showing a statistically significant difference(P<0.05).A total of 145 patients completed follow-up,with a median follow-up time of 718.0(501.5,991.0)days,among which 73 patients(50.3%)experienced relapses.At the last follow-up,73 patients(50.3%)received continued preventive immunotherapy,with a median treatment duration of 998.0(633.5,1937.0)days.The top three immunotherapy used during remission were mycophenolate mofetil,rituximab,and azathioprine.The median ARR at the last follow-up decreased to 0.10(0.00,0.71),which showed a statistically significant difference from the baseline(P<0.05).COX multivariate regression analysis showed that antinuclear antibody(ANA)positive(HR=2.471,95%CI:1.266 to 4.823)and rituximab treatment(HR=3.365,95%CI:1.021 to 11.089)were associated with a red

关 键 词：视神经脊髓炎谱系疾病 免疫治疗 复发因素 

分 类 号：R977.9[医药卫生—药品] R744.5[医药卫生—药学]