视神经脊髓炎谱系疾病血清胱抑素C水平与临床特征的相关性

Serum cystatin C level and its relationship with clinical features in neuromyelitis optical spectrum disorder

目的探讨急性期视神经脊髓炎谱系疾病(NMOSD)患者血清胱抑素C水平与临床特征的关系。方法选择2015年9月至2018年5月就诊于作者医院的NMOSD患者37例、多发性硬化(MS)患者20例及健康对照组43名,采用免疫比浊法检测各组血清胱抑素C水平,采用扩展残疾状态量表(EDSS)评价NMOSD患者的严重程度,行磁共振评估病灶,采用间接免疫荧光法检测患者血清水通道蛋白4(AQP4)抗体。分析NMOSD患者血清胱抑素C水平与病程、病情轻重、脊髓病灶节段、是否存在颅内病灶及AQP4抗体的相关性。结果 NMOSD组血清胱抑素C水平显著低于对照组[(0.83±0.12)mg/L比(0.91±0.10)mg/L,P<0.01],与MS组[(0.86±0.10)mg/L]比较差异无统计学意义(P>0.05)。EDSS评分≥5分的NMOSD患者血清胱抑素C水平[(0.78±0.10)mg/L]低于EDSS<5分的患者[(0.88±0.12)mg/L;t=2.98,P<0.01],有颅内病灶者其水平[(0.77±0.11)mg/L]低于无颅内病灶者[(0.87±0.12)mg/L;t=2.81,P<0.01]。病程、脊髓受累节段及AQP4抗体阳性与否与Cys C水平无明显相关(P>0.05)。结论 NMOSD患者血清胱抑素C水平降低,并且与病情严重程度及是否存在颅内病变有关。

Objective To study the relationship between serum cystatin C(Cys C)level and clinical features in the acute phase of neuromyelitis optical spectrum disorder(NMOSD).Methods We collected 37 patients as the NMOSD group,20 patients as the multiple sclerosis(MS)group and 43 healthy subjects as the control group between September 2015 and May 2018.Immunoturbidimetry was employed to measure the serum Cys C concentration.The disability severity in NMOSD was assessed by the Expanded Disability Status Scale(EDSS).Magnetic resonance imaging(MRI)was performed to assessment the involved lesions.Serum antiaquaporin-4(AQP4)antibody was tested in a cell-based immunofluorescence assay.We further performed subgroup analyses stratified by the course of the disease,length of spinal lesions,EDSS score,the presence of intracranial lesions and AQP4 antibody titer in NMOSD patients.Results Patients with NMOSD had lower serum Cys C concentrations [(0.83±0.12)mg/L]compared to the control group[(0.91±0.10)mg/L,P<0.01]but not the MS group[(0.86±0.10)mg/L,P >0.05].Serum Cys C levels were significantly lower in NMOSD patients with EDSS≥5 than those with EDSS<5[(0.78±0.10)mg/Lvs.(0.88±0.12)mg/L;t=2.98,P<0.01].NMOSD patients with intracranial lesions had lower levels of Cys C than those without intracranial lesions [(0.77±0.11)mg/Lvs.(0.87±0.12)mg/L;t=2.81,P<0.01].Serum Cys C was not related to the course of the disease,length of spinal lesions and AQP4 antibody titer in NMOSD patients(P >0.05).Conclusions Lower serum Cys C levels were found in patients with NMOSD and related to severe condition and intracranial lesions.