血清脂类指标对视神经脊髓炎谱系疾病诊断价值的回顾性分析

Retrospective analysis of serum lipids in the diagnosis of neuromyelitis optica spectrum disorders

目的探讨视神经脊髓炎谱系疾病(NMOSD)患者血清脂类指标的诊断价值,并分析其与NMOSD临床特征的关系。方法回顾性分析2018年1月-2020年7月于解放军总医院第一医学中心神经内科和眼科确诊的324例NMOSD患者(NMOSD组)、147例多发性硬化(MS)患者(MS组),以及252名无神经系统受累者(健康对照组)的临床及实验室诊断相关信息。采用logistic回归控制年龄、性别、病程、病变部位、各血清脂类指标间的相互作用,分析三组研究对象的血清总胆固醇(TC)、三酰甘油(TG)、载脂蛋白A1(Apo A1)、载脂蛋白B(Apo B)、高密度脂蛋白(HDL)和低密度脂蛋白(LDL)水平,以及各指标在NMOSD急性期、复发期、缓解期中的水平差异。根据AQP4抗体效价高低、受累部位不同等NMOSD临床特征进一步分组,分析各指标在不同亚组间的水平差异。结果NMOSD患者中位病程为20个月,MRI显示受累部位主要为视神经(198/324,61.1%);MS患者中位病程较长(48个月),呈多部位受累(56/147,38.1%)。NMOSD组与MS组、健康对照组TC、Apo A1、LDL、Apo B水平差异有统计学意义(P<0.05)。亚组分析结果显示,NMOSD急性期、复发期、缓解期三个亚组中,仅急性期与复发期Apo B水平差异有统计学意义(P<0.05);NMOSD不同主要受累部位TC、Apo A1、Apo B、HDL、LDL水平差异有统计学意义(P<0.05)。ROC曲线分析显示,联合血清TC、Apo A1、Apo B、LDL预测NMOSD的AUC为0.732,敏感度为57.86%,特异度为81.15%。结论联合血清TC、Apo A1、Apo B、LDL能较好地特异性诊断NMOSD,且Apo A1和Apo B可分别作为提示受累部位和NMOSD疾病活动程度的指标。

Objective To investigate the diagnostic efficacy of serum lipids in patients with neuromyelitis optica spectrum disorders(NMOSD),and to analyze the relationship between serum lipids and clinical features of NMOSD.Methods The clinical and laboratory diagnosis information of 324 patients with NMOSD(NMOSD group),147 patients with multiple sclerosis(MS,MS group)and 252 healthy controls(HCs,HCs group)were collected from the First Medical Center of PLA General Hospital from January 2018 to July 2020.Logistic regression analysis was used to control the age,gender,disease duration,affected sites and the interaction of various serum lipid indexes.The differences of serum total cholesterol(TC),triglyceride(TG),Apolipoprotein A1(Apo A1),Apolipoprotein B(Apo B),high-density lipoprotein(HDL)and low-density lipoprotein(LDL)in three groups of patients were analyzed,and the concentration differences of each index in the acute stage,relapse stage and remission stage of NMOSD were also analyzed.According to the clinical features of NMOSD,such as AQP4 antibody titer and affected sites,the concentration difference of lipid index in different subgroups was analyzed.Results The average disease duration in the NMOSD group was 20 months,and magnetic resonance imaging(MRI)showed that the most affected region is the optic nerve(198/324,61.1%).In the MS group,the disease duration was longer(48 months)and multiple sites were affected(56/147,38.1%).There were significant differences in TC,Apo A1,LDL,TG and Apo B between NMOSD group and MS group or HCs group(P<0.05).Subgroup analysis showed that only Apo B was significantly different in the acute stage,relapse stage and remission stage of NMOSD group(P<0.05).Further analysis on the subgroups of NMOSD showed that there were significant differences in TC,Apo A1,Apo B,HDL and LDL in different sites(P<0.05).The receiver operating characteristic(ROC)analysis showed that the combination of serum TC,Apo A1,Apo B and LDL could specifically diagnose NMOSD with the AUC of 0.732,sensitivity of 57.86%and specificity of 81.15%.Conclusion The combination of serum TC,Apo A1,Apo B and LDL can specifically diagnose NMOSD,and Apo A1 and Apo B can be used as indicators of affected sites and disease activity of NMOSD respectively.