MOG抗体阳性相关ADEM的治疗及预后分析

Treatment and prognostic analysis of MOG antibody positive ADEM

目的探讨髓鞘少突胶质细胞糖蛋白(MOG)抗体阳性相关急性播散性脑脊髓炎(ADEM)的治疗及预后分析。方法选取2016年1月~2020年6月我院收治的90例MOG抗体阳性相关ADEM患者,根据治疗方法不同将其分为对照组和观察组,每组各45例。观察患者临床症状,对比治疗前后两组免疫功能指标及症状持续时间。结果患者临床症状主要为发热、瘫痪、意识障碍、颈项强直等;经头颅MRI检查显示,皮质下脑白质斑片状病变占25.56%、皮质受累占23.33%、基底节病变占17.78%、脑干受累占16.67%、脑白质受累占11.11%;治疗后,观察组免疫指标水平低于对照组,发热、意识障碍、颈项强直症状持续时间均短于对照组,两组比较差异均有统计学意义(均P<0.05)。结论 MOG抗体阳性相关ADEM患者临床表现与头颅MRI检查结果多样,采取甲基泼尼龙联合人免疫球蛋白治疗效果更佳,可提高患者免疫力,促进临床症状恢复,多数患者预后良好。

Objective To investigate the treatment and prognosis analysis of acute disseminated encephalomyelitis(ADEM)associated with positive myelin oligodendrocyte glycoprotein(MOG)antibody.Methods 90 patients with MOG antibody positive ADEM who were admitted to our hospital from January 2016 to June 2020 were selected,and divided into control groups and observation group according to different treatment methods,45 cases in each group.The patient's clinical symptoms were observed,and the immune function indexes and symptom duration of the two groups before and after treatment were compared.Results The clinical symptoms of patients were mainly fever,paralysis,disturbance of consciousness,neck rigidity,etc.The MRI examination of head showed that subcortical white matter patchy lesions(25.56%),cortex involvement(23.33%),basal ganglia lesions(17.78%),brain stem involvement(16.67%),white matter involvement(11.11%);After treatment,in the observation group,the levels of the immune function indexes were significantly lower than those in the control group;the duration of fever,disturbance of consciousness and neck ankylosis were shorter than that in the control group.The difference between two groups were all statistically significant(all P<0.05).Conclusion The clinical manifestations and head MRI findings of MOG antibody positive ADEM were diverse.Methylprednisolone combined with human immunoglobulin is more effective,which can improve the immunity of patients and promote the recovery of clinical symptoms,and most patients have a good prognosis.