抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病三例误诊分析

Misdiagnosed Analyses of Three Patients with Anti-myelin Sheath Oligodendrocyte Glycoprotein Immunoglobulin G Antibody Associated Disorders

目的探讨抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体(MOG-IgG)相关疾病(MOGAD)的临床特点、误诊原因及防范措施。方法回顾性分析2018年11月—2020年8月误诊为其他疾病的3例MOGAD患者的临床资料。结果1例出现渐进加重的双下肢乏力伴二便障碍,根据相关检查,误诊为结核性脑脊髓炎,给予抗结核治疗2个月后出现双眼无痛性视力下降伴色觉减退、光感减弱;1例出现由下向上发展的双下肢麻木乏力,误诊为脊髓压迫症,后经影像学检查误诊为脊髓亚急性联合变性;1例出现头痛、眼痛伴发热,经脑脊液、脑电图检查误诊为病毒性脑炎,给予抗病毒治疗效果不佳。3例均应用细胞分析法检测血清或脑脊液MOG-IgG阳性后明确诊断为MOGAD,其中2例给予甲泼尼龙治疗联合吗替麦考酚酯口服维持,1例给予甲泼尼龙冲击联合免疫球蛋白治疗。3例随访3~12个月,除误诊为结核性脑脊髓炎的患者眼部症状无明显改善外,余患者预后尚可。结论MOGAD为临床少见病,发病率较低,临床症状、脑脊液表现、MRI均缺乏特异性,临床医师需提高对MOGAD的认识,遇此类患者尽早完善血清及脑脊液MOG-IgG检测,拓宽诊断思维以减少误诊误治。

Objective To investigate clinical characteristics,misdiagnosed causes and preventive measures of anti-myelin sheath oligodendrocyte glycoprotein immunoglobulin G antibody(MOG-IgG)associated disorders(MOGAD).Methods Clinical data of 3 patients with MOGAD misdiagnosed as HAVING other diseases during November 2018 and August 2020 was retrospectively analyzed.Results One patient suffered from progressively worsening of anergy in both lower limbs and urine and stool dysfunction,and then tuberculous encephalomyelitis was misdiagnosed according to relevant examinations,but the patient had painless impaired vision with decreased color vision and light perception in both eyes after 2 months of anti-tuberculosis treatment.One patient had numbness and anergy in both lower limbs that developed from bottom to top,and spinal cord compression was misdiagnosed,and then subacute combined degeneration of spinal cord was misdiagnosed by imaging examination.One patient suffered from headache and eye pain associated by fever,and viral meningitis was misdiagnosed by cerebrospinal fluid and electroencephalogram examinations,and antiviral treatment led to poor treatment outcomes.The 3 patients were confirmed as having MOGAD after results of positive serum or cerebrospinal fluid MOG-IgG were detected by cell analysis.Two patients were treated with Methylprednisolone combined with Mycophenolate Mofetil for oral maintenance,and other 1 patient was treated with intravenous pulses of Methylprednisolone combined with immunoglobulin therapy.Three patients were followed up for 3 to 12 months.Ocular symptoms of one patient who was misdiagnosed as having tuberculous encephalomyelitis were not significantly improved,and prognoses of the other two patients were fairly good.Conclusion MOGAD is rare in clinic,and it has lower incidence rate,and its clinical symptoms,cerebrospinal fluid manifestations and MRI findings lack specificity.Clinicians should improve their understanding of MOGAD,perform serum and cerebrospinal fluid MOG-IgG detection as soon as possible and broaden diagnostic thinking to reduce misdiagnosis and mistreatment.