妊娠 流产致APQ4抗体阴性的NMOSD复发1例报道
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摘要
目的提高对妊娠、流产致视神经脊髓炎谱系疾病(NMOSD)复发相关性认识。方法报道1例妊娠、流产后导致APQ4抗体阴性的NMOSD复发患者,结合文献复习进行分析。结果该例患者为妊娠、流产后导致NMOSD复发,查血清及脑脊液APQ4抗体、MOG抗体均阴性,诊断APQ4抗体阴性的NMOSD明确。经激素及免疫球蛋白等治疗,预后良好。结论 NMOSD与妊娠、流产关系密切,两者相互影响。本病例APQ4抗体、MOG抗体阴性,说明复发除与APQ4抗体、MOG抗体有关外,尚有其他可能的发病机制。
Objective To improve the understanding of the correlation of neuromyelitis optica spectrum disorders(NMOSD) induced by pregnancy and abortion.Metheds One case of neuromyelitis optica spectrum disorders(NMOSD) with APQ4 antibody-negative in pregnancy and abortion was reported.Meanwhile,the relevant literatures were reviewed.Results In this case,NMOSD recurrence was caused by pregnancy and abortion,APQ4 antibody-negative and MOG antibody-negative were detected in serum and cerebrospinal fluid,the diagnosis of NMOSD with APQ4 antibody-negative is clear.Prognosis was good after treatment with hormone and immunoglobulin.Conclusion NMOSD is closely related to pregnancy and abortion.They interact with each other.In this case,APQ4 antibody-negative and MOG antibody-negative indicates that there are other possible pathogenesis of NMOSD recurrence besides the association with APQ4 antibody and MOG antibody.
Objective To improve the understanding of the correlation of neuromyelitis optica spectrum disorders(NMOSD) induced by pregnancy and abortion.Metheds One case of neuromyelitis optica spectrum disorders(NMOSD) with APQ4 antibody-negative in pregnancy and abortion was reported.Meanwhile,the relevant literatures were reviewed.Results In this case,NMOSD recurrence was caused by pregnancy and abortion,APQ4 antibody-negative and MOG antibody-negative were detected in serum and cerebrospinal fluid,the diagnosis of NMOSD with APQ4 antibody-negative is clear.Prognosis was good after treatment with hormone and immunoglobulin.Conclusion NMOSD is closely related to pregnancy and abortion.They interact with each other.In this case,APQ4 antibody-negative and MOG antibody-negative indicates that there are other possible pathogenesis of NMOSD recurrence besides the association with APQ4 antibody and MOG antibody.
引文
[1] 黄艳露,邱伟.视神经脊髓炎谱系疾病与妊娠:临床及机制研究进展[J].中华神经科杂志,2016,49(6):493-495.
[2] 仝延萍,杨涛,康越之,等.妊娠对视神经脊髓炎谱系疾病与多发性硬化病程的影响[J].中国神经免疫学和神经病学杂志,2018,25(1):11-14.
[3] AKAISHI T,NAKASHIMA I,SATO D K,et al.Neuromyelitis Optica Spectrum Disorders.[J].Neuroimaging clin N Am,2017,27(2):251-265.
[4] 侯晓丹,刘晓加.视神经脊髓炎谱系疾病患者妊娠相关问题的研究进展[J].中国实用神经疾病杂志,2018,21(3):344-348.
[5] JACOB A,MCKEON A,NAKASHIMA I,et al.Current concept of neuromyelitis optica (NMO) and NMO spectrum disorders[J].J Neurol Neurosurg psychiatry,2013,84(8):922-930.
[6] 黄艳露,黄巧,卢婷婷,等.中国人视神经脊髓炎谱系疾病及多发性硬化与妊娠的相关性[J].中山大学学报(医学科学版),2017,38(2):267-272.
[7] 黄鑫,徐妃妃,钱海蓉,等.表现为超长节段脊髓炎的视神经脊髓炎谱系疾病的临床特征[J].中华医学杂志 2018,98(21):1 658-1 663.
[8] 陈绘颖,艾飞飞,覃小清,等.AQP4-IgG阳性、阴性视神经脊髓炎谱系疾病临床资料比较[J].山东医药,2018,58(27):63-65.
[9] YAN Y,LI Y,FU Y,et al.Autoantibody to MOG suggests two distinct clinical subtypes of NMOSD[J].Sci China Life Sci,2016,59(12):1 270-1 281.
[10] WINGERCHUK D M,LENNON V A,LUCCHIN-ETTI C F,et al.The spectrum of neuromyelitis optica[J].Lancet Neurol,2007,6(9):805-815.
[11] 杨彩平,牛慧艳,王海,等.伴顽固性低钠血症的AQP4阴性视神经脊髓炎谱系疾病1例报告[J].中风与神经疾病杂志,2019,36(2):157-159.
[12] SELLNERER J,BOGGILD M,CLANET M,et al.EFNS guidelines on diagnosis and management of neuromyelitis optica[J].Neurology.2015,84(11):1 165-1 173.
[13] WINGERCHUK D M,BANWELL B,BENNETT J L,et al.International consensus diagnostic criteria for neuromyelitis optica spectrum disorders[J].Neurology,2015,85(2):177-189.
[14] KOWARIK MC,ASTLING D,GASPERI C,et al.CNS aquaporin-4-specific B cells connect with multiple B-cell compartments in neuromyelitis optica spectrum disorder[J].Ann Clin Transl Neurol,2017,4(6):369-380.
[15] SATO D K,CALLEGARO D,LANAPEIXOTO M A,et al.Distinction between MOG antibodypositive and AQP4 antibody-positive NMO spectrum disorders[J].Neurology,2014,82(6):474-481.
[16] AMIRY-MOGHADDAM M,OTTERSEN O.The molecular basis of water transport in the brain[J].Nat Rev Neurosci,2003,4:991-1001.
[17] SATO D K,LANAPEIXOTO M A,FUJIHARA K,et al.Clinical spectrum and treatment of neuromyelitis optica spectrum disorders:evolution and current status[J].Brain Pathol,2013,23:647-660.
[18] 陆军,胡朋,贾潇,等.14例视神经脊髓炎谱系疾病临床、实验室及影像学特点分析[J].徐州医科大学学报,2018,38(4):261-265.
[19] JARIUS S,WILDEMANN B.AQP4 antibodies in neuromyelitis optica:diagnostic and pathogenetic relevance[J].Nat Rev Neurol,2010,6(7):383-392.
[20] SIRITHO S,APIWATTANAKUL M,NAKASHIMA I,et al.Features of antiaquaporin 4 antibody-seronegative Thai patients with neuromyelitis optica spectrum disorders:a comparison with seropositive cases[J].J Neurol Sci,2014,341(1-2):17-21.
[21] JARIUS S,RUPRECHT K,WILDEMANN B,Contrasting disease patterns in seropositive and seronegative neuromyelitis optica:A multicentre study of 175 patients.[J].J Neuroinflammation,2012,9:14.
[22] 马如雪,于秀军.水通道蛋白4抗体阳性与阴性视神经脊髓炎谱系疾病发病机制及临床特点比较分析[J].中国神经免疫学和神经病学杂志,2018,25(4):292-298.
[23] HUPPKE P,BLUTHNER M,BAUER O,et al.Neuromyelitis optica and NMO-IgG in European pediatric patients[J].Neurology,2010,75(19):1 740-1 744.
[24] 尤小凡,叶静,李存江,等.视神经脊髓炎IgG抗体与临床相关性研究[J].中华医学杂志,2010,90(35):2 477-2 480.
[25] CARNERO C E,HRYB J P,MORALES S,et al.Longitudinally extensive transverse myelitis immune-mediated in aquaporin-4 antibody negative patients:Disease heterogeneity[J].J Neurol Sci,2017,373:134-137.
[26] 白亚楠,赵代弟,赵聪,等.基于2015年版诊断标准的视神经脊髓炎谱系疾病临床与影像学特征分析[J].中国现代神经疾病杂志,2016,16(9):582-590.
[27] 陈绘颖,艾飞飞,覃小清,等.APQ4-IgG 阳性、阴性视神经脊髓炎谱系疾病临床资料比较[J].山东医药,2018,58(27):63-65.
[28] 厉向,童巧文,柯建明,等.血清水通道蛋白4抗体测定对视神经脊髓炎的诊断及预后判断价值[J].中国病理生理杂志,2014,30(11):1 974-1 979.
[29] 闫巧梅.妊娠期视神经脊髓炎及其治疗分析[J].中国卫生标准管理,2014,5(21)71-72.
[30] MAJED M,FRYER J P,MCKEON A,et al.Clinical utility of testing AQP4-IgG in CSF:Guidance for physicians[J].Neurol Neuroimmunol Neuroinflamm,2016,3:231.
[31] TUZUN,ERDEM,TZARTOS,et al.Aquaporin-1 Antibody in Neuromyelitis Optica Patients[J].Eur Neurol,2014,72(5-6):271-272.
[32] JARIUS S,WANDINGER K P,BOROWSKI K,et al.Antibodies to CV2/CRMP5 in neuromyelitis optica-like disease:Case report and review of the literature[J].Clin Neurol Neurosurg,2012,114(4):331-335.
[33] PANDIT L,SATO D K,MUSTAFA S,et al.Serological markers associated with neuromyelitis optica spectrum disorders in South India[J].Ann Indian Acad Neurol,2016,19(4):505-509.
[34] LONG Y,ZHENG Y,SHAN F,et al.Development of a cell-based assay for the detection of anti-aquaporin 1 antibodies in neuromyelitis optica spectrum disorders[J].J Neuroimmunol,2014,273(1/2):103-110.
[35] KITLEY J,WATERS P,WOODHALL M,et al.Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies:a comparative study[J].JAMA Neurol,2014,71(3):276-283.
[36] 姚海燕,黄清梅,邱伟,等.MOG抗体阳性视神经脊髓炎谱系疾病临床和影像学特点[J].中国神经精神疾病杂志,2018,44(11):646-650.
[37] PELT E D,WONG Y Y,KETELSLEGERS I A,et al.Neuromyelitis optica spectrum disorders:comparison of clinical and magnetic resonance imaging characteristics of AQP4-IgG versus MOG-IgG seropositive cases in the Netherlands[J].Eur J Neurol,2016,23(3):580-587.
[38] RAMANATHAN S,DALE RC,BRILOT F.Anti-MOG antibody:the history,clinical phenotype,and pathogenicity of a serum biomarker for demyelination[J].Autoimmun Rev,2016,15(4):307-324.
[39] WINGERCHUK D M,LENNON V A,PITTOCK S J,et al.Revised diagnostic criteria for neuromyelitis optica[J].Neurology,2006,66(10):1 485-1 489.
[40] SHIMIZU Y,FUJIHARA K,OHASHI T,et al.Pregnancy-related relapse risk factors inwomen with anti-AQP4 antibody positivity and neuromyelitisoptica spectrum disorder[J].Mult Scler,2016,22(11):1 413-1 420.
[41] NOUR M M,NAKASHIMA I,COUTINHO E,et al.Pregnancy outcomes in aquaporin-4-positive neuromyelitis optica spectrum disorder[J].Neurology,2016,86(1):79-87.
[42] IGEL C,GARRETTO D,ROBBINS M S,et al.Neuromyelitis optica in pregnancy complicated by posterior reversible encephalopathy syndrome,eclampsia and fetal death[J].J Clin Med Res,2015,7(3):193-195.
[43] ROBINSON D P,KLEIN S L.Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis[J].Horm Behav,2012,62(3):263-271.
[44] SAITO S,NAKASHIMA A,SHIMA T,et al.Th1/Th2/Th17 and Regulatory T-Cell Paradigm in Pregnancy[J].Am J Reprod Immunol,2010,63(6):601-610.
[2] 仝延萍,杨涛,康越之,等.妊娠对视神经脊髓炎谱系疾病与多发性硬化病程的影响[J].中国神经免疫学和神经病学杂志,2018,25(1):11-14.
[3] AKAISHI T,NAKASHIMA I,SATO D K,et al.Neuromyelitis Optica Spectrum Disorders.[J].Neuroimaging clin N Am,2017,27(2):251-265.
[4] 侯晓丹,刘晓加.视神经脊髓炎谱系疾病患者妊娠相关问题的研究进展[J].中国实用神经疾病杂志,2018,21(3):344-348.
[5] JACOB A,MCKEON A,NAKASHIMA I,et al.Current concept of neuromyelitis optica (NMO) and NMO spectrum disorders[J].J Neurol Neurosurg psychiatry,2013,84(8):922-930.
[6] 黄艳露,黄巧,卢婷婷,等.中国人视神经脊髓炎谱系疾病及多发性硬化与妊娠的相关性[J].中山大学学报(医学科学版),2017,38(2):267-272.
[7] 黄鑫,徐妃妃,钱海蓉,等.表现为超长节段脊髓炎的视神经脊髓炎谱系疾病的临床特征[J].中华医学杂志 2018,98(21):1 658-1 663.
[8] 陈绘颖,艾飞飞,覃小清,等.AQP4-IgG阳性、阴性视神经脊髓炎谱系疾病临床资料比较[J].山东医药,2018,58(27):63-65.
[9] YAN Y,LI Y,FU Y,et al.Autoantibody to MOG suggests two distinct clinical subtypes of NMOSD[J].Sci China Life Sci,2016,59(12):1 270-1 281.
[10] WINGERCHUK D M,LENNON V A,LUCCHIN-ETTI C F,et al.The spectrum of neuromyelitis optica[J].Lancet Neurol,2007,6(9):805-815.
[11] 杨彩平,牛慧艳,王海,等.伴顽固性低钠血症的AQP4阴性视神经脊髓炎谱系疾病1例报告[J].中风与神经疾病杂志,2019,36(2):157-159.
[12] SELLNERER J,BOGGILD M,CLANET M,et al.EFNS guidelines on diagnosis and management of neuromyelitis optica[J].Neurology.2015,84(11):1 165-1 173.
[13] WINGERCHUK D M,BANWELL B,BENNETT J L,et al.International consensus diagnostic criteria for neuromyelitis optica spectrum disorders[J].Neurology,2015,85(2):177-189.
[14] KOWARIK MC,ASTLING D,GASPERI C,et al.CNS aquaporin-4-specific B cells connect with multiple B-cell compartments in neuromyelitis optica spectrum disorder[J].Ann Clin Transl Neurol,2017,4(6):369-380.
[15] SATO D K,CALLEGARO D,LANAPEIXOTO M A,et al.Distinction between MOG antibodypositive and AQP4 antibody-positive NMO spectrum disorders[J].Neurology,2014,82(6):474-481.
[16] AMIRY-MOGHADDAM M,OTTERSEN O.The molecular basis of water transport in the brain[J].Nat Rev Neurosci,2003,4:991-1001.
[17] SATO D K,LANAPEIXOTO M A,FUJIHARA K,et al.Clinical spectrum and treatment of neuromyelitis optica spectrum disorders:evolution and current status[J].Brain Pathol,2013,23:647-660.
[18] 陆军,胡朋,贾潇,等.14例视神经脊髓炎谱系疾病临床、实验室及影像学特点分析[J].徐州医科大学学报,2018,38(4):261-265.
[19] JARIUS S,WILDEMANN B.AQP4 antibodies in neuromyelitis optica:diagnostic and pathogenetic relevance[J].Nat Rev Neurol,2010,6(7):383-392.
[20] SIRITHO S,APIWATTANAKUL M,NAKASHIMA I,et al.Features of antiaquaporin 4 antibody-seronegative Thai patients with neuromyelitis optica spectrum disorders:a comparison with seropositive cases[J].J Neurol Sci,2014,341(1-2):17-21.
[21] JARIUS S,RUPRECHT K,WILDEMANN B,Contrasting disease patterns in seropositive and seronegative neuromyelitis optica:A multicentre study of 175 patients.[J].J Neuroinflammation,2012,9:14.
[22] 马如雪,于秀军.水通道蛋白4抗体阳性与阴性视神经脊髓炎谱系疾病发病机制及临床特点比较分析[J].中国神经免疫学和神经病学杂志,2018,25(4):292-298.
[23] HUPPKE P,BLUTHNER M,BAUER O,et al.Neuromyelitis optica and NMO-IgG in European pediatric patients[J].Neurology,2010,75(19):1 740-1 744.
[24] 尤小凡,叶静,李存江,等.视神经脊髓炎IgG抗体与临床相关性研究[J].中华医学杂志,2010,90(35):2 477-2 480.
[25] CARNERO C E,HRYB J P,MORALES S,et al.Longitudinally extensive transverse myelitis immune-mediated in aquaporin-4 antibody negative patients:Disease heterogeneity[J].J Neurol Sci,2017,373:134-137.
[26] 白亚楠,赵代弟,赵聪,等.基于2015年版诊断标准的视神经脊髓炎谱系疾病临床与影像学特征分析[J].中国现代神经疾病杂志,2016,16(9):582-590.
[27] 陈绘颖,艾飞飞,覃小清,等.APQ4-IgG 阳性、阴性视神经脊髓炎谱系疾病临床资料比较[J].山东医药,2018,58(27):63-65.
[28] 厉向,童巧文,柯建明,等.血清水通道蛋白4抗体测定对视神经脊髓炎的诊断及预后判断价值[J].中国病理生理杂志,2014,30(11):1 974-1 979.
[29] 闫巧梅.妊娠期视神经脊髓炎及其治疗分析[J].中国卫生标准管理,2014,5(21)71-72.
[30] MAJED M,FRYER J P,MCKEON A,et al.Clinical utility of testing AQP4-IgG in CSF:Guidance for physicians[J].Neurol Neuroimmunol Neuroinflamm,2016,3:231.
[31] TUZUN,ERDEM,TZARTOS,et al.Aquaporin-1 Antibody in Neuromyelitis Optica Patients[J].Eur Neurol,2014,72(5-6):271-272.
[32] JARIUS S,WANDINGER K P,BOROWSKI K,et al.Antibodies to CV2/CRMP5 in neuromyelitis optica-like disease:Case report and review of the literature[J].Clin Neurol Neurosurg,2012,114(4):331-335.
[33] PANDIT L,SATO D K,MUSTAFA S,et al.Serological markers associated with neuromyelitis optica spectrum disorders in South India[J].Ann Indian Acad Neurol,2016,19(4):505-509.
[34] LONG Y,ZHENG Y,SHAN F,et al.Development of a cell-based assay for the detection of anti-aquaporin 1 antibodies in neuromyelitis optica spectrum disorders[J].J Neuroimmunol,2014,273(1/2):103-110.
[35] KITLEY J,WATERS P,WOODHALL M,et al.Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies:a comparative study[J].JAMA Neurol,2014,71(3):276-283.
[36] 姚海燕,黄清梅,邱伟,等.MOG抗体阳性视神经脊髓炎谱系疾病临床和影像学特点[J].中国神经精神疾病杂志,2018,44(11):646-650.
[37] PELT E D,WONG Y Y,KETELSLEGERS I A,et al.Neuromyelitis optica spectrum disorders:comparison of clinical and magnetic resonance imaging characteristics of AQP4-IgG versus MOG-IgG seropositive cases in the Netherlands[J].Eur J Neurol,2016,23(3):580-587.
[38] RAMANATHAN S,DALE RC,BRILOT F.Anti-MOG antibody:the history,clinical phenotype,and pathogenicity of a serum biomarker for demyelination[J].Autoimmun Rev,2016,15(4):307-324.
[39] WINGERCHUK D M,LENNON V A,PITTOCK S J,et al.Revised diagnostic criteria for neuromyelitis optica[J].Neurology,2006,66(10):1 485-1 489.
[40] SHIMIZU Y,FUJIHARA K,OHASHI T,et al.Pregnancy-related relapse risk factors inwomen with anti-AQP4 antibody positivity and neuromyelitisoptica spectrum disorder[J].Mult Scler,2016,22(11):1 413-1 420.
[41] NOUR M M,NAKASHIMA I,COUTINHO E,et al.Pregnancy outcomes in aquaporin-4-positive neuromyelitis optica spectrum disorder[J].Neurology,2016,86(1):79-87.
[42] IGEL C,GARRETTO D,ROBBINS M S,et al.Neuromyelitis optica in pregnancy complicated by posterior reversible encephalopathy syndrome,eclampsia and fetal death[J].J Clin Med Res,2015,7(3):193-195.
[43] ROBINSON D P,KLEIN S L.Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis[J].Horm Behav,2012,62(3):263-271.
[44] SAITO S,NAKASHIMA A,SHIMA T,et al.Th1/Th2/Th17 and Regulatory T-Cell Paradigm in Pregnancy[J].Am J Reprod Immunol,2010,63(6):601-610.