不同IgG抗体转归的髓鞘少突胶质细胞糖蛋白抗体相关疾病临床和影像学特征及其影响因素  

Clinical and imaging characteristics and influencing factors of myelin oligodendrocyte glycoprotein antibody‑associated disease with different IgG antibody conversions

作　　者：贾楠[1] 王佳伟[1] 朱丽平[1] 赖春涛[1] Jia Nan;Wang Jiawei;Zhu Liping;Lai Chuntao(Department of Neurology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院神经内科,北京100730

出　　处：《中华医学杂志》2024年第45期4140-4145,共6页National Medical Journal of China

摘　　要：目的探讨不同IgG抗体转归的髓鞘少突胶质细胞糖蛋白抗体(MOG‑IgG)相关疾病(MOGAD)患者的临床、影像学特征,分析影响转归的因素。方法回顾性收集2019年1月至2023年4月在首都医科大学附属北京同仁医院神经内科确诊为MOGAD的患者,随访截止至2024年5月,比较MOG‑IgG转阴组与非转阴组的临床及影像学特征,采用多因素logistic回归模型分析MOG‑IgG转阴的影响因素。结果51例患者男23例,女28例,入组年龄(38.3±16.4)岁。转阴组14例(27.5%),非转阴组37例(72.5%)。转阴组患者初始血清MOG‑IgG滴度<1∶100的比例(10/14)及入组时为首次发作的比例(11/14)均高于非转阴组[40.5%(15/37)、21.6%(8/37),均P<0.05]。转阴组年复发率(ARR)[M(Q1,Q3)]0(0,0.2)低于非转阴组[0.5(0.1,1.0),P=0.001]。转阴组临床表型及影像学均未见脊髓受累,7/14视神经MRI仅眶内段受累,高于非转阴组[13.5%(5/37),P=0.018]。随访时间18.1(14.3,37.3)个月,转阴组首次发病至血清MOG‑IgG转阴时间4.5(2.8,11.5)个月,2例持续转阴后复发,复发时1例血清MOG‑IgG复阳,1例阴性。入组时为首次发作(OR=86.788,95%CI:1.436~5244.198,P=0.033)、初始血清MOG‑IgG滴度低(OR=10.840,95%CI:1.239~94.845,P=0.031)的患者血清MOG‑IgG更易转阴。结论视神经仅眶内段受累、无脊髓受累更多见于MOG‑IgG转阴患者。首次临床发作、初始MOG‑IgG滴度低的MOGAD患者血清MOG‑IgG更易转阴。Objective To investigate the clinical and imaging characteristics of patients with myelin oligodendrocyte glycoprotein antibody(MOG‑IgG)‑associated disease(MOGAD)with different MOG‑IgG seroconversions,and to analyze the factors affecting the conversion.Methods Retrospective study.Patients diagnosed with MOGAD in the Department of Neurology,Beijing Tongren Hospital,Capital Medical University from January 2019 to April 2023 were included and the follow‑up ended in May 2024.The clinical and imaging characteristics of MOG‑IgG negative conversion group and non‑negative conversion group were compared.A multivariate logistic regression model was used to analyze the influencing factors of MOG‑IgG negative conversion.Results A total of 51 patients were enrolled,including 23 males and 28 females,aged(38.3±16.4)years.There were 14 cases(27.5%)in the negative conversion group and 37 cases(72.5%)in the non‑negative conversion group.The proportion of patients with initial serum MOG‑IgG titer<1∶100(10/14)and the proportion of patients with first attack(11/14)at the inception in the negative conversion group were higher than those in the non‑negative conversion group[40.5%(15/37),21.6%(8/37),P<0.05].The annual relapse rate(ARR)of the negative conversion group was[M(Q1,Q3)]0(0,0.2)and was significantly lower than that of the non‑negative conversion group 0.5(0.1,1.0)(P=0.001).No spinal cord involvement was found in the clinical classification and imaging of the negative conversion group,and 7/14 of the optic nerve MRI was only involved in the intraorbital segment,which was higher than that of the non‑negative conversion group[13.5%,(5/37),P=0.018].The median follow‑up time was 18.1(14.3,37.3)months,and the median time from initial onset to serum MOG‑IgG negative was 4.5(2.8,11.5)months in the negative conversion group,two cases in the negative conversion group relapsed after continuous negative conversion,one case relapsed with MOG‑IgG positive and the other with negative.The first attack at the i

关 键 词：髓鞘少突胶质细胞糖蛋白 IgG 滴度 复发 巢式病例对照研究 

分 类 号：R741[医药卫生—神经病学与精神病学]