视神经脊髓炎谱系疾病53例与多发性硬化11例的脑脊液检测比较

Comparison of cerebrospinal fluid detection in 53 patients with neuromyelitis optica spectrum disorder and 11 patients with multiple sclerosis

目的探讨水通道蛋白4抗体(AQP4-IgG)阳性的视神经脊髓炎谱系疾病(NMOSD)与多发性硬化(MS)患者脑脊液细胞学、生化及寡克隆区带指标差异。方法选取符合入组标准的血清AQP4-IgG阳性的NMOSD患者53例(NMOSD组)与MS患者11例(MS组),入院48 h内完成腰椎穿刺并进行脑脊液细胞学、生化及寡克隆区带检测,比较两组间差异。结果NMOSD组与MS组性别比例差异无统计学意义(P=0.665),NMOSD组年龄高于MS组,差异有统计学意义(P=0.043)。NMOSD组与MS组相比,脑脊液白细胞计数升高比例差异无统计学意义(P=0.074),白细胞计数前者高于后者(P=0.028)。NMOSD组乳酸水平高于MS组,差异有统计学意义(P=0.041);其他变量两组间差异无统计学意义(P>0.05)。NMOSD根据其临床及影像学表现分为脊髓炎亚组、视神经炎亚组和脑损伤亚组,在不同亚组中,白细胞计数在81.3%(26/32)的脊髓炎中升高,视神经炎亚组和脑损伤亚组中白细胞升高比例分别为60%(3/5)和50%(3/6)。单核细胞和淋巴细胞出现在所有NMOSD样本中,仅3例NMOSD患者脑脊液中检测到中性粒细胞,MS患者中未观察到中性粒细胞的存在。此外,NMOSD脊髓炎患者脑脊液白细胞计数与脊髓损伤长度呈显著相关,脑脊液总蛋白、IgG/M/A、乳酸水平与脊髓损伤长度无相关。结论AQP4-IgG阳性的NMOSD患者脑脊液白细胞计数与乳酸水平高于MS患者;脑脊液白细胞计数与脊髓损伤具有相关性。

Objective To investigate the cytological,biochemical and oligoclonal band results of cerebrospinal fluid(CSF)between patients with aquaporin-4 immunoglobulin(AQP4-IgG)positive neuromyelitis optica spectrum disorder(NMOSD)and multiple sclerosis(MS).Methods A total of 53 AQP4-IgG seropositive NMOSD patients(NMOSD group)and 11 MS patients(MS group)who met the inclusion criteria were selected.Lumbar puncture was completed within 48 hours after admission and CSF cytology,biochemistry and oligoclonal band detection were performed to compare the results.Results There was no significant difference in sex ratio between the two groups(P=0.665),while the NMOSD group had significantly older age than the MS group(P=0.043).Although there was no significant difference in the proportion of increased CSF white cell count between the two groups(P=0.074),the NMOSD group had higher count than the MS group(P=0.028).The lactate level in NMOSD group was significantly higher than that in MS group(P=0.041).No statistical differences were found in the other variables between the two groups(P>0.05).According to the clinical and imaging results,the NMOSD patients were divided into"myelitis","optic neuritis"and"brain lesion"subgroups,whose white cell count increased by 81.3%(26/32),60%(3/5)and 50%(3/6),respectively.Monocytes and lymphocytes were present in all NMOSD samples.Neutrophils were detected in only 3 NMOSD patients and no neutrophils were observed in MS patients.In addition,CSF white cell count was significantly correlated with the spinal cord lesion length in NMOSD myelitis patients,while CSF total protein,IgG/M/A and lactate levels were not significantly correlated with the spinal cord lesion length.Conclusion The white cell count and lactate levels in CSF of AQP4-IgG seropositive NMOSD patients are higher than those of MS patients.The white cell count in CSF is correlated with spinal cord injury.