单纯性视神经炎水通道蛋白4抗体检验临床评价

Clinical significance of aquaporin-4 autoantibodies assay for optic neuritis

目的了解对单纯性视神经炎患者行水通道蛋白4(AQP-4)抗体检验的阳性率;评价AQP-4抗体检测对判断单纯性视神经炎患者是否最终转归为视神经脊髓炎(NMO)的临床价值。方法收集首诊于我院神经眼科的视神经炎患者99例,在末次发病1个月内进行AQP-4抗体检测并分组,AQP-4抗体阳性患者为A组,AQP-4抗体阴性患者为B组。患者经相同激素治疗方案治疗后随访6个月至1年,明确2组患者NMO的转归率。采用校正卡方法对数据资料进行统计学分析。结果 99例患者中81例AQP-4抗体阴性,18例为AQP-4抗体阳性,阳性率为19.9%;随访期间74例(除外7例患者不能随访)AQP-4抗体阴性患者有1例最终诊断为NMO,16例(除外2例患者不能随访)AQP-4抗体阳性患者有6例最终诊断为NMO,A组和B组差异有统计学意义(P<0.05,x2=19.9)。结论部分首诊于眼科的视神经炎患者可以归为视神经脊髓炎疾病谱,对单纯视神经炎患者行AQP-4抗体检验可能有助于帮助眼科临床医师判断孤立性视神经炎患者转归为NMO的风险,及时请神经内科会诊,达到早期发现并指导治疗NMO的目的。

OBJECTIVE To investigate the positive rate of aquaporin-4（AQP-4）autoantibodies in isolated optic neuritis（ON）;To evaluate the diagnostic value of AQP-4 autoantibodies assay in patients with isolated optic neuritis who may progressed to optical neuromyelitis（NMO）.METHODS Followed by perspective study to diagnose 99 patients individually.All patients had been performed AQP-4 autoantibodies assay.Ninety-nine patients were divided into two groups： seropositivity（group A）,seronegativity（group B）.In order to identify the conversion rate,all patients were treated by intravenous methylprednisolone and oral prednisone,which had been followed-up between 6 months and 1 year.RESULTS Eighteen out of 99 patients were seropositive.The positive rate was 19.9%.In group A,6 out of 16 seropositive patients were diagnosed as optical neuromyelitis（NMO）finally（except 2 cases could not be followed-up）.In group B,1 out of 74 seronegative patients was diagnosed as optical neuromyelitis（NMO）（7cases could not be followed-up）.There were significant differences between group A and group B.P0.05,x 2=19.9.CONCLUSIONS Partial ON cases belong to neuromyelitis optical spectrum.AQP-4 autoantibodies assay is valuable for helping clinical ophthalmologist to assessing ON development,judging prognosis and selecting clinical therapy.