抗核抗体谱阳性的视神经脊髓炎患者的临床和磁共振特征分析

Clinical and magnetic resonance imaging features of neuromyelitis optics with positive anti-nuclear antibody serum

目的探讨血清抗核抗体谱（ANAs）阳性的视神经脊髓炎（NMO）患者的临床和脑、脊髓磁共振成像特征。方法将2006--2011年首都医科大学宣武医院收治的34例视神经脊髓炎，分为抗核抗体谱阳性组（14例）和抗核抗体谱阴性组（20例），回顾性分析两组NMO患者的临床资料[包括首次发作的残疾状态扩展评分（EDSS）、首次缓解期持续时间、第一年复发阳性率等]，总结脑、脊髓磁共振成像特征。结果（1）NMO抗核抗体谱阳性组和阴性组首次发作EDSS评分分别为（2．8±1．1）分、（2．3±0．8）分，首次缓解期持续时间分别为（9±9）个月、（31±39）个月，第一年复发阳性比例分别为10／14、6／20，两组之间差异有统计学意义（P〈0．05）。（2）NMO抗核抗体谱阳性组的磁共振脑损害阳性率为5／14，高于抗核抗体谱阴性组（5／20），但二者之间差异无统计学意义；抗核抗体谱阳性组颈段脊髓单独受累多于胸段脊髓（分别为6／14、1／14），抗核抗体谱阴性组胸段脊髓单独受累多于颈髓（分别为6／20、4／20）。结论抗核抗体谱阳性的NMO患者临床首次发作神经功能损伤严重，缓解期短，第一年内疾病易复发，易出现脑损害及颈段脊髓损害。

Objective To analyze the clinical features and brain, spinal cord magnetic resonance imaging （MRI） features of neuromyelitis optica （NMO）patients with positive anti-nuclear antibody serum （ANAs）. Methods The clinical data of expanded disability status scale （EDSS） score, duration of the first relieving phase and first year recurrence-positive rate and MRI features of 34 NMO patients at our hospital during the period of 2006 - 2011 were retrospectively reviewed and divided into two groups according to the outcome of antibodies test ： ANAs positive group （ n = 14） and ANAs negative group （ n = 20）. Results （ 1 ） In the ANAs-positive group, the EDSS score of first NMO attack was （2. 8 ± 1.1 ）, first remission continued to （9 ±9）months and the first year recurrence-positive rate was 71.0% ; in the ANAs-negative group, the EDSS score of first NMO attack was 2. 3 ±0. 8, first remission continued to （31 ± 39） months and the first year recurrence-positive rate was 30. 0%. The differences in the first attack EDSS score, duration of first remission and first recurrence rate between two groups were statistically significant （P 〈 0. 05）. （2） Brain damage-positive rate in the ANAs-positive group on prompt MRI was 35.71% （5/14） and it was higher than that in ANAs-negative group （5/20）. But no significant difference existed between two groups. The spinal cord lesions were predominantly located in cervical and thoracic spinal cords simultaneously in both groups （about 50% respectively）. And, in the ANAs-positive group, the cervical lesions involved were much more common than the thoracic counterparts （6/14 vs 1/14）. However, in the ANAs-negative group, thoracic segments were usually involved （6/20 vs 4/20）. Conclusion With severe neurological deficits in the first clinical attack and a short remission, ANAs-positive NMO patients are more prone to relapse in the first year, brain damage and cervical cord injury.