血清水通道蛋白4抗体与脑脊液寡克隆区带双阳性视神经脊髓炎谱系疾病患者临床特点研究

A study of clinical features of patients diagnosed with neuromyelitis optica spectrum disorders who were both AQP4-Ab seropositive and cerebrospinal fluid OB positive

目的探讨血清水通道蛋白4(aquaporin-4,AQP4)抗体及脑脊液寡克隆区带(oligoclonal bands,OB)均阳性视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)患者的临床特点。方法。收集2013-02—2014-12期间于作者医院神经内科确诊为NMOSD患者60例的病例资料,进行回顾性分析。患者分为双阳组(血清AQP4抗体及脑脊液OB均阳性)、单阳组(仅血清AQP4抗体阳性)和双阴组(血清AQP4抗体及脑脊液OB阴性)。分析三组患者临床资料。结果 60例患者双阳组患者20例,单阳组患者25例,双阴组患者15例。三组患者累计发作次数差异有统计学意义[双阳组4.2次,单阳组4.0次,双阴组2.4次,x2=9.00,P=0.011]。双阳组患者累计发作次数最多。三组患者核MRI上胸髓及脑干病灶比例差异有统计学意义(χ~2=7.42,P=0.025;χ~2=7.55,P=0.023)。双阳组胸髓病灶比例高于双阴组[85.00%(17)vs.46.67%(7),χ~2=5.84,P=0.016];双阴组脑干病灶比例高于单阳组[60.00%(9)vs.20.00%(5),χ~2=6.59,P=0.010]。三组患者自身免疫病相关抗体[包括抗SSA抗体(Sjogren's syndrome A antibody,SSA-Ab)、抗SSB抗体(Sjogren's syndrome B antibody,SSB-Ab)、抗Ro-52抗体、甲状腺微粒体抗体(thyroid peroxidase antibody,TPO-Ab)、甲状腺球蛋白抗体(thyroglobulin antibody,TG-Ab)]阳性率差异有统计学意义[双阳组60.00%,单阳组24.00%,双阴组6.67%,χ~2=12.43,P=0.002)。双阳组患者自身免疫病相关抗体阳性率高于单阳组及双阴组(χ~2=6.00,P=0.014;χ~2=10.44,P=0.001)。三组之间神经功能状态评分差异有统计学意义[双阳组(4.15±1.822)分,单阳组(4.60±1.814)分,双阴组(2.97±1.642)分,F=4.021,P=0.023)]。单阳组EDSS评分高于双阴组(t=2.853,P=0.007)。结论血清AQP4抗体及脑脊液OB均阳性的NMOSD患者累计发作次数多,胸髓病灶比例高,脑干病灶比例低,易同时携带多种自身免疫病相关抗体。

Objective To evaluate the clinical features of patients with NMOSD who were both AQP4-Ab seropositive and cerebrospinal fluid OB positive.Methods All data of patients with NMOSD were retrospectively collected in our neurology department from 2013-02 to 2014-12.Those patients were divided into three groups as double positive group,single positive group and negative group.Patients in the double positive group were both serum AQP4-Ab and cerebrospinal fluid OB positive.Patients in the single positive group were just AQP4-Ab seropositive.Patients who were AQP4-Ab and OB both negative were named negative group.Clinical characteristics were analyzed among the three groups.Results Sixty patients participated in the research.There were 20 patients in the double positive group,25 patients in the single positive group and 15 in the negative group.There were significant differences in the frequencies of attacks among those groups（4.2 vs.4.0 vs.2.4,χ^2=9.00,P =0.011）.Compared with others,participants in the double positive group had the highest frequency of attacks.The rates of patients with thoracic spinal cord and brainstem lesions in magnetic resonance imaging were significantly different among the three groups（χ^2=7.42,P=0.025;χ^2=7.55,P=0.023）.The rate of patients with thoracic spinal cord lesions in the double positive group was higher than the negative group[85.00（17%）vs.46.67（7%）,χ^2=5.84,P=0.016].The rate of patients with brainstem lesions in the negative group was higher in the single positive group [60.00（9%）vs.20.00（5%）;χ^2=6.59,P=0.010].The positive incidences of antibodies associated with autoimmune diseases were remarkably different among the three groups（χ^2=12.43,P=0.002）.Double positive group had more antibodies associated with autoimmune disease compared with others（χ^2=6.00,P =0.014;χ^2=10.44,P =0.001）.There were prominent differences in EDSS in the three groups（F=4.021,P=0.023）.Compared with the single positive group,patients in the negative group had lower scores（t=2.853,P=0.007）.Conclusions Patients diagnosed with NMOSD who are both AQP4-Ab seropositive and cerebrospinal fluid OB positive may have higher frequencies of attacks,higher rate of thoracic spinal cord affection and more antibodies associated with autoimmune disease.