视神经脊髓脱髓鞘疾病谱AQP-4抗体检测意义及临床相关分析

Detection and clinical relevance of AQP-4 antibody in demyelinating opticospinal diseases

目的通过对中枢神经系统脱髓鞘疾病患者空腹AQP-4抗体检测,探讨视神经脊髓型多发性硬化(OSMS)的归属,进一步阐明抗AQP-4自身抗体检测在整个视神经脊髓疾病谱中的重要性。方法收集中枢神经系统脱髓鞘疾病患者65例,分析其磁共振成像(MRI)、扩展的残障功能评分、AQP-4抗体检测结果等临床相关数据。结果视神经脊髓炎(NMO)患者15例,OSMS患者17例,多发性硬化(MS)和其他患者共33例。抗AQP-4抗体检测的敏感度和特异度分别为83.3%和86.1%。OSMS组患者血清AQP-4抗体阳性率(64.7%)显著高于MS组(6%),而OSMS组患者AQP-4阳性者11例为脊髓病变>3个脊髓段长且广泛性损害的患者。并且NMO和OSMS疾病组AQP-4抗体阳性率组间比较差异无统计学意义(P>0.05);OSMS患者在发病年龄、MRI检查等方面与NMO极其相似。结论 AQP-4抗体的检测有助于鉴别NMO、OSMS、MS以及其他炎性脱髓鞘疾病。

Objective To determine the serum aquaporin-4（AQP-4） antibody in patients with inflammatory demyelinating diseases of the central nervous system,so as to investigate the nosological attribution of opticospinal multiple sclerosis（OSMS） ,and to clarify the clinical relevance of anti-AQP4 autoimmunity in the whole spectrum of neuromyelitis optica（NMO） . Methods A total of 65 patients with inflammatory demyelinating diseases of the central nervous system（NMO,n=15;OSMS,n=17;MS and the others,n=33） were included and evaluated for MRI,serum AQP-4 antibody,and extended disability status scale（EDSS） . Results The sensitivity and specificity of anti-AQP4 antibody assay was 83.3% and 86.1%,respectively. The positive rate of anti-AQP4 antibody was significantly higher in OSMS patients（13/48,64.7%） than in those with MS（3/54,6%） ,but did not differ between NMO and OSMS（P0.05） . The vast majority of OSMS patients detected with positive AQP4 were with longitudinally extensive spinal cord lesions（LESCLs） involving over three vertebral segments. Conclusion OSMS is very similar to NMO in terms of patient age and MRI features. Detection of AQP-4 antibody can be valuable for differential diagnosis among NMO,OSMS,MS and other diseases.