早发型与晚发型视神经脊髓炎谱系疾病患者的临床特点分析

目的:分析早发型(EO-NMOSDs)与晚发型视神经脊髓炎谱系疾病患者(LO-NMOSDs)不同的临床特征。方法:纳入2015年1月至2022年12月海南医学院第一附属医院收治的51例首次在我院确诊的视神经脊髓炎谱系疾病患者,根据发病年龄是否≥50岁分为EO-NMOSDs组22例和LO-NMOSDs组29例。统计分析两组患者的基本资料、扩展残疾状态量表(EDSS)评分、血和脑脊液化验指标。结果:两组间在人口学特征、临床特征及血清AQP-4抗体阳性率方面均无统计学意义(均P>0.05),在甘油三酯、低密度脂蛋白、载脂蛋白A、载脂蛋白B和脂蛋白a上有统计学差异(分别为P=0.010、P=0.048、P=0.014、P=0.061、P=0.001),以及脑脊液乳酸脱氢酶、微量蛋白定量和EDSS评分有统计学差异(分别为P=0.018、P=0.034、P=0.025),其中LO-NMOSDs脑脊液微量蛋白定量的水平与患者残疾程度有一定的相关性(r=0.52,P<0.03)。结论:LO-NMOSDs与EO-NMOSDs组患者具有相似的人口统计学特征、血清AQP-4抗体阳性率及临床特征,但与EO-NMOSDs相比,LO-NMOSDs组患者易患有脂质代谢异常,脑脊液中有较高的微量蛋白以及更易致残,并且在LO-NMOSDs中,脑脊液微量蛋白越高,患者的致残状况越重。

Analysis of clinical characteristics of leptomeningeal metastasis with band-like high signal in the brainstem

Objective:The aim was to analyse the clinical features of leptomeningeal metastasis with banded high signal in the brainstem.Methods:In this paper,we report two cases of lung adenocarcinoma with soft meningeal metastasis,collected from the First Affiliated Hospital of Hainan Medical College,and searched the databases of CNKI,Wanfang,VIP,PubMed,Web of Science,and other databases which reported the MRI manifestation of"brainstem bandlike high signal",and collected the patients'past medical history,symptoms,signs,genetic findings,cerebrospinal fluid manifestation,treatment,and prognosis.Result:A total of 28 patients were included,of whom 26 had a history of lung adenocarcinoma and 2 were found to have occupational changes in the lungs.Magnetic resonance imaging(MRI)showed a band-like high signal in the ventral part of the brainstem on T2-FLAIR,symmetrical on both sides,which could extend to the cerebellar peduncles,with high signals on diffusion-weighted imaging(DWI),low signals on apparent diffusion coefficient(ADC),and long T1 signals on T1-weighted imaging,long T2 signals on T2 weighted imaging,and no long T2 signals on enhancement scan.T1-weighted imaging was a long T1 signal,T2-weighted imaging was a long T2 signal,and no enhancement was seen on enhanced scanning.Conclusion:It is important to recognize leptomeningeal metastasis of lung cancer,and the non-enhancing band of high signal in the brainstem on T2-FLAIR and DWI is likely to be the characteristic manifestation of leptomeningeal metastasis of non-small cell lung cancer.

Clinical characteristics of patients with early-and late-onset optic neuromyelitis optica spectrum disease

Objective:To analyze the different clinical features of patients with early-onset(EO-NMOSDs)and late-onset neuromyelitis optica spectrum diseases(LO-NMOSDs).Methods:A total of 51patients with neuromyelitis optica spectrum disease who were diagnosed in our hospital for the first time from January 2015 to December 2022 were included in the First Affiliated Hospital of Hainan Medical College and divided into 22 cases in the EO-NMOSDs group and 29 cases in the LO-NMOSDs group according to whether the age of onset was 50 years old.The basic data,Extended Disability Status Scale(EDSS)score,blood and cerebrospinal fluid test indicators of the two groups were statistically analyzed.Results:There were no significant differences in demographic characteristics,clinical features and serum AQP-4 antibody positivity rate between the two groups(all P>0.05),and there were significant differences in triglycerides(TG),low-density lipoprotein(LDL),apolipoprotein A(APOA),apolipoprotein B(APOB)and lipoprotein a(P=0.010,P=0.048,P=0.014,P=0.061,P=0.001,respectively),and cerebrospinal fluid LDH,There were significant differences between microprotein quantification and EDSS score(P=0.018,P=0.034,P=0.025,respectively),and the level of microprotein quantification in cerebrospinal fluid of LO-NMOSDs had a certain correlation with the degree of disability(r=0.52,P<0.03).Conclusion:LO-NMOSDs and EO-NMOSDs group patients have similar demographic characteristics,serum AQP-4 antibody positive rate and clinical features,but compared with EO-NMOSDs,patients in LO-NMOSDs group are prone to abnormal lipid metabolism,higher trace proteins in cerebrospinal fluid and more likely to be disabled,and among LO-NMOSDs,the higher the trace protein in the cerebrospinal fluid,the more severe the disability status of patients.