106例抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体阳性与抗水通道蛋白4免疫球蛋白G抗体阳性视神经炎患者临床特征比较及预后因素分析

Comparison of clinical features and prognostic factors of 106 optic neuritis patients with anti-myelin oligodendrocyte glycoprotein immunoglobulin G antibody positive and anti-aquaporin 4 immunoglobulin G antibody positive

目的比较抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体(MOG-IgG)阳性与抗水通道蛋白4免疫球蛋白G抗体(AQP4-IgG)阳性视神经炎或伴有视神经炎的视神经脊髓炎谱系疾病(NMOSD)患者的临床特征,并分析其预后因素。方法共收集2018年7月至2019年8月于首都医科大学附属北京同仁医院神经内科以视神经炎为主要表现、血清抗体阳性的住院连续病例106例,根据血清抗体型别分为MOG-IgG阳性视神经炎(MOG-ON)组(35例)及AQP4-IgG阳性视神经炎(AQP4-ON)组(71例),平均随访14.9个月(5~26个月),比较不同血清型别视神经炎患者的临床特征及转归差别,并进行不同转归的预后因素分析。结果与AQP4-ON患者比较,MOG-ON患者男性[37.1%(13/35)比15.5%(11/71),χ²=6.274]、双眼受累[48.6%(17/35)比19.7%(14/71),χ^(2)=9.432]、伴眼痛[82.9%(29/35)比62.0%(44/71),χ²=4.770]、视盘水肿[63.5%(33/52)比36.5%(31/85),χ^(2)=9.442]及盘周出血[15.4%(8/52)比2.4%(2/85),χ²=6.286]较多见,其他自身免疫指标异常较少见[11.4%(4/35)比52.1%(37/71),χ^(2)=16.360](均P<0.05)。与AQP4-ON类似,MOG-ON广泛累及幕上、幕下和颈、胸髓脊髓长节段及视路各段,但视神经眶内段前部受累较AQP4-ON多见(χ^(2)=17.506,P<0.001),而视神经鞘膜受累少于AQP4-ON(χ²=4.075,P=0.044)。MOG-ON患者发病3个月矫正视力≥0.5的比例(92.3%,48/52)高于AQP4-ON患者(50.0%,34/68)(χ²=24.374,P<0.001),血清MOG-IgG阳性是视神经炎视力恢复的有利因素[OR(95%CI):11.537(2.090~63.690)],起病年龄大[OR(95%CI):0.945(0.908~0.983)]、伴有其他神经系统受累[OR(95%CI):0.116(0.031~0.439)]、视神经鞘膜受累[OR(95%CI):0.246(0.066~0.916)]是不利因素。MOG-ON的复发率(37.1%,13/35)低于AQP4-ON(59.2%,42/71;χ^(2)=4.550,P=0.033),伴有其他神经系统受累是视神经炎复发的促进因素[OR(95%CI):6.908(2.312~20.634)]。结论相比AQP4-ON患者,MOG-ON患者男性多见,更多表现为双眼痛性视力下降、伴视盘水肿及盘周出血、视神经眶内段前部受累,而视神经鞘膜受累以及合并其他自身免疫抗体阳性相对少见。MOG-ON患者较AQP4-ON患者治疗后视力恢复较好,复发较少。起病年龄大、伴有其他神经系统受累、视神经鞘膜受累是视神经炎恢复的不利因素,伴有其他神经系统受累也是视神经炎复发的促进因素。

Objective To compare the clinical features of patients with anti-myelin oligodendrocyte glycoprotein immunoglobulin G antibody(MOG-IgG)positive and anti-aquaporin 4 immunoglobulin G antibody(AQP4-IgG)positive optic neuritis or neuromyelitis optic spectrum disorders(NMOSD)along with optic neuritis,and to analyze prognostic factors.Methods A total of 106 consecutive inpatients with optic neuritis as the main manifestation and with positive serum antibodies were collected in Department of Neurology,Beijing Tongren Hospital,Capital Medical University from July 2018 to August 2019.The patients were divided into MOG-IgG-positive optic neuritis(MOG-ON)group(35 cases)and AQP4-IgG-positive optic neuritis(AQP4-ON)group(71 cases)according to serum antibody type.The average follow-up period was 14.9 months(5-26 months).The clinical features and outcomes of patients with different serotypes of optic neuritis were compared,and the prognostic factors for different outcomes were analyzed.Results Compared with AQP4-ON patients,MOG-ON patients were more common in males[37.1%(13/35)vs 15.5%(11/71),χ²=6.274],binocular involvement[48.6%(17/35)vs 19.7%(14/71),χ²=9.432],ocular pain[82.9%(29/35)vs 62.0%(44/71),χ²=4.770],papilledema[63.5%(33/52)vs 36.5%(31/85),χ²=9.442]and peripapillary hemorrhage[15.4%(8/52)vs 2.4%(2/85),χ²=6.286],and were rare in abnormality of other autoimmune indexes[11.4%(4/35)vs 52.1%(37/71),χ²=16.360](all of them P<0.05).Similar to AQP4-ON,supratentorial and infratentorial tissues,the long segments of the cervical and thoracic cord and all parts of visual pathway were widely involved in MOG-ON,but the anterior segment of optic nerve in orbital was more frequently involved in MOG-ON than in AQP4-ON(χ²=17.506,P<0.001),while the optic nerve sheath was less involved in MOG-ON than in AQP4-ON(χ²=4.075,P=0.044).The proportion of corrected visual acuity≥0.5 in MOG-ON patients(92.3%,48/52)post three-month of disease onset was higher than that in AQP4-ON patients(50.0%,34/68)(χ^(2)=24.374,P<0.001).Positive serum MOG-IgG was a favorable factor for vision acuity recovery in optic neuritis[OR(95%CI):11.537(2.090-63.690)],while older onset age[OR(95%CI):0.945(0.908-0.983)],involvement with other nervous system[OR(95%CI):0.116(0.031-0.439)],and involvement of optic nerve sheath[OR(95%CI):0.246(0.066-0.916)]were adverse factors.The recurrence rate of MOG-ON(37.1%,13/35)was lower than that of AQP4-ON(59.2%,42/71;χ^(2)=4.550,P=0.033).The presence of other nervous system involvement was the promoting factor of optic neuritis recurrence[OR(95%CI):6.908(2.312-20.634)].Conclusions Compared with AQP4-ON,MOG-ON patients are more common in men,presenting with binocular painful vision loss,optic disc edema and peri-disc hemorrhage,and involvement of the anterior orbital segment of the optic nerve,while involvement of the optic nerve sheath and other autoimmune index abnormalities are relatively rare.MOG-ON patients have better vision recovery and fewer recurrence after treatment than AQP4-ON.Older age of onset,participation of other nervous system,and immersion of optic nerve sheath,are adverse factors for recovery of optic neuritis,and involvement of other nervous system is also a promoting factor for recurrence of optic neuritis.