MOG-IgG阳性儿童急性播散性脑脊髓炎影响因素分析

Influencing factors for acute disseminated encephalomyelitis in children with MOG-IgG positive

目的分析髓鞘少突胶质细胞糖蛋白(MOG)-IgG阳性儿童的急性播散性脑脊髓炎(ADEM)的影响因素。方法根据MOG-IgG检测结果将41例ADEM患儿分为MOG-IgG阳性组(18例)和MOG-IgG阴性组(23例),选取同期健康体检的儿童24例作为对照组。检测外周血淋巴细胞亚群计数和血清细胞因子水平,采用多因素logistic回归分析MOG-IgG阳性儿童ADEM的影响因素,ROC曲线分析IFN-γ和IL-17A对MOG-IgG阳性儿童ADEM的预测价值。结果MOG-IgG阳性组CD4+/CD8+比值低于对照组,B淋巴细胞相对计数高于对照组(P<0.05);MOG-IgG阳性组淋巴细胞相对计数最低,对照组最高(P<0.05)。MOG-IgG阳性组和MOG-IgG阴性组淋巴细胞、T淋巴细胞、Th细胞和NK细胞绝对计数低于对照组(P<0.05)。MOG-IgG阳性组和MOG-IgG阴性组IL-2水平低于对照组(P<0.05);MOG-IgG阴性组IL-6、TNF-α、IFN-γ水平高于MOG-IgG阳性组和对照组(P<0.05);MOG-IgG阳性组IL-17A水平高于MOG-IgG阴性组(P<0.05)。IFN-γ较低和IL-17A较高是MOG-IgG阳性ADEM的独立危险因素(P<0.05)。取IFN-γ联合IL-17A诊断时,其预测MOG-IgG阳性儿童ADEM的灵敏度为70.6%,特异度为95.7%。结论MOG-IgG阳性和MOG-IgG阴性ADEM患儿外周血淋巴细胞亚群和血清细胞因子水平存在差异,IFN-γ较低和IL-17A较高是MOG-IgG阳性儿童ADEM的独立危险因素,IFN-γ联合IL-17A可用于预测MOG-IgG阳性ADEM。

Objective To analyze the influencing factors for acute disseminated encephalomyelitis(ADEM)in the children with myelin oligodendrocyte glycoprotein(MOG)-IgG positive.Methods A total of 41 children with ADEM were divided into groups of A(MOG-IgG positive,18 cases)and B(MOG-IgG negative,23 cases)according to MOG-IgG examination results.Twenty-four healthy children were taken as the controls(group C).The peripheral blood lymphocyte subsets and serum cytokines were detected.The influencing factors for ADEM in the children with MOG-IgG positive were analyzed by multivariate logistic regression analysis.The predictive value of IFN-γand IL-17A for ADEM with MOG-IgG positive was analyzed by ROC curve.Results The CD4+/CD8+ratio was lower,and the relative count of B lymphocytes was higher in group A than those in group C(P<0.05).The relative count of lymphocytes was in an order of group C>group B>group A(P<0.05).The absolute counts of lymphocytes,T lymphocytes,T helper cells and NK cells were lower in groups of A and B than those in group C(P<0.05).The level of IL-2 in groups of A and B was lower than that in group C(P<0.05).The levels of IL-6,TNF-αand IFN-γwere higher in group B than those in groups of A and C(P<0.05).The level of IL-17A was higher in group A than that in group B(P<0.05).The lower IFN-γand higher IL-17A were the independent risk factors for MOG-IgG positive ADEM(P<0.05).When it was diagnosis of IFN-γcombined with IL-17A,the sensitivity and specificity for predicting MOG-IgG positive ADEM were 70.6%and 95.7%,respectively.Conclusion The peripheral blood lymphocyte subsets and serum cytokines are different between the ADEM children with MOG-IgG positive and negative.The lower IFN-γand higher IL-17A are the independent risk factors for Mog-IgG positive ADEM.IFN-γcombined with IL-17A could be used to predict ADEM in the children with MOG-IgG positive.