132例视神经脊髓炎患者眼部特征及水通道蛋白4抗体浓度分析

A retrospective study of ocular manifestations and aquaporin 4 antibody concentrations in 132 patients with neuromyelitis optica

目的观察视神经脊髓炎(NMO)患者眼部特征、血清水通道蛋白4抗体(AQP-4Ab)滴度,初步分析AQP-4Ab不同滴度患者BCVA预后情况。方法回顾性病例研究。2009年9月至2014年3月在复旦大学附属华山医院神经内科和眼科检查确诊的NMO患者132例纳入研究。首次发病累及视神经74例(56.06%),其中单纯累及视神经63例(47.72%),同时累及视神经及脊髓者11例(8.33%);2次及以上复发者83例(62.88%)。患者均行BCVA、裂隙灯显微镜、眼底检查以及甲状腺功能、性激素、血清AQP-4Ab检测。记录患者入院时及治疗后出院前BCVA,双眼发病者记录BCVA更差眼;对比观察AQP-4Ab不同滴度患者BCVA情况。结果首次发病累及视神经74例中,初诊时BCVA<0.1者50例(67.57%);AQP-4Ab阳性者56例,其中血清AQP-4Ab滴度5~60、61~100、>100RSRU/ml者分别为13、9、34例。治疗2周后,BCVA改善40例(71.42%),其中AQP-4Ab滴度5~60、61~100、>100RSRU/ml者分别为11(84.62%)、6(66.67%)、23(67.64%)例。132例中,AQP-4Ab阳性者98例(74.24%);免疫类风湿指标异常者73例(55.30%)。结论NMO患者中56.06%的患者首次发病累及视神经,其中67.57%的患者视力较差眼BCVA<0.1;血清AQP-4Ab滴度5~60RSRU/ml者BCVA预后较好。

Objective To observe the ocular manifestations and the titer of aquaporin 4 antibody(AQP-4) in NMO patients, and to evaluate the BCVA prognosis in patients with different titers of AQP-4Ab. Methods A retrospective case study. From September 2009 to March 2014, 132 NMO patients diagnosed in Department of Neurology and Ophthalmology in Huashan Hospital of Fudan University were included in the study. Among the patients, 74 patients (56.06%) were involved in optic nerve for the first time, among which 63 patients (47.72%) were involved in optic nerve alone, and 11 patients (8.33%) were involved in optic nerve and spinal cord at the same time. The recurrence rate was 62.88%(twice or more). All patients underwent BCVA, slit lamp microscope, fundus examination, thyroid function, sex hormones, and serum AQP-4Ab detection. BCVA was recorded at admission and before discharge from hospital, and worse BCVA was recorded in binocular patients. The BCVA of patients with different titers of AQP-4Ab were analyzed comparatively. Results Among the 74 patients with optic nerve involved in the first onset, 50 patients with BCVA<0.1 at the initial diagnosis(67.57%);AQP-4Ab positive was found in 56 patients, which including 13, 9 and 34 patients of AQP-4Ab titer 5 - 60, 61 - 100 and >100 RSRU/ml. After 2 weeks of treatment, BCVA improved in 40 patients (71.42%), including 11 (84.62%), 6 (66.67%) and 23 (67.64%) of AQP-4Ab titer 5 - 60, 61 - 100 and > 100 RSRU/ml. Among 132 patients, 98 patients (74.24%) were AQP-4Ab positive. There were 73 patients (55.30%) with abnormal immune rheumatoid index. Conclusions The optic nerve is involved in 56.06% patients with NMO for the first time, and 67.57% of the patients had poor vision with BCVA<0.1. BCVA prognosis is better in patients with serum AQP-4Ab titer of 5 - 60 RSRU/ml.