自身免疫抗体对视神经脊髓炎谱系疾病的影响
|
摘要
目的:探讨自身免疫抗体对视神经脊髓炎谱系疾病(NMOSD)的影响。方法:收集2012年1月至2015年1月在广西医科大学第一、第二附属医院治疗的74例NMOSD患者资料,根据抗水通道蛋白4抗体(AQP4-IgG)及自身免疫抗体检测结果分为4组:AQP4-IgG(+)自身免疫抗体(+)组、AQP4-IgG(+)自身免疫抗体(-)组、AQP4-IgG(-)自身免疫抗体(+)组和AQP4-IgG(-)自身免疫抗体(-)组。对比分析4组临床资料、颅脑及脊髓MRI、视觉诱发电位及随访3年的复发率及复发次数。结果:4组患者性别、首发症状、首次发病残疾状态量表(EDSS)评分、MRI及视觉诱发电位比较,差异均无统计学意义(均P>0.05);AQP4-IgG(-)自身免疫抗体(-)组首次发病年龄较AQP4-IgG(+)自身免疫抗体(+)及AQP4-IgG(+)自身免疫抗体(-)组小(P<0.05);AQP4-IgG(+)自身免疫抗体(+)组及AQP4-IgG(+)自身免疫抗体(-)组的复发率及复发次数均显著高于AQP4-IgG(-)自身免疫抗体(-)组(P<0.05);AQP4-IgG(+)自身免疫抗体(+)的复发次数高于AQP4-IgG(+)自身免疫抗体(-)组(P<0.05)。双变量相关分析提示,AQP4-IgG及自身免疫抗体均与复发次数呈正相关关系(r=0.377,P=0.0004;r=0.327,P=0.002)。结论:自身免疫抗体(ANA、SSA、SSB、JO-52)可作为评估NMOSD预后的参考指标。
Objective:To investigate the effect of autoimmune antibodies on neuromyelitis optica spectrum disorders(NMOSD).Methods:The clinical data from 74 patients with NMOSD were collected,and the patients were divided into 4 groups according to the aquaporin 4(AQP4)-IgG and autoimmune antibodies detection results.The clinical manifestations,MRI of the brain and spinal cord,visual evoked potential,and recurrence rate were compared.Results:There were no significant differences in gender,initial symptoms,initial Expanded Disability Status Scale(EDSS)score,MRI manifestations and visual evoked potentials among the four groups.The AQP4-IgG(-)autoimmune antibodies(-)patients were younger than those of AQP4-IgG(+)autoimmune antibodies(+)and AQP4-IgG(+)autoimmune antibodies(-)(P<0.05).AQP4-IgG(+)autoimmune antibodies(+)and AQP4-IgG(+) autoimmune antibodies(-)patients had higher recurrence rate and times than those of AQP4-IgG(-)autoimmune antibodies(-)(P<0.05).The times of recurrence in AQP4-IgG(+)autoimmune antibodies(+)was higher compared with AQP4-IgG(+)autoimmune antibodies(-)(P<0.05).AQP4-IgG and autoimmune antibodies were positively correlated with the recurrence times(r=0.377,P =0.0004;r=0.327,P =0.002).Conclusion:Autoimmune antibodies(ANA,SSA,SSB,JO-52)could be markers to evaluate NMOSD patients' prognosis.
Objective:To investigate the effect of autoimmune antibodies on neuromyelitis optica spectrum disorders(NMOSD).Methods:The clinical data from 74 patients with NMOSD were collected,and the patients were divided into 4 groups according to the aquaporin 4(AQP4)-IgG and autoimmune antibodies detection results.The clinical manifestations,MRI of the brain and spinal cord,visual evoked potential,and recurrence rate were compared.Results:There were no significant differences in gender,initial symptoms,initial Expanded Disability Status Scale(EDSS)score,MRI manifestations and visual evoked potentials among the four groups.The AQP4-IgG(-)autoimmune antibodies(-)patients were younger than those of AQP4-IgG(+)autoimmune antibodies(+)and AQP4-IgG(+)autoimmune antibodies(-)(P<0.05).AQP4-IgG(+)autoimmune antibodies(+)and AQP4-IgG(+) autoimmune antibodies(-)patients had higher recurrence rate and times than those of AQP4-IgG(-)autoimmune antibodies(-)(P<0.05).The times of recurrence in AQP4-IgG(+)autoimmune antibodies(+)was higher compared with AQP4-IgG(+)autoimmune antibodies(-)(P<0.05).AQP4-IgG and autoimmune antibodies were positively correlated with the recurrence times(r=0.377,P =0.0004;r=0.327,P =0.002).Conclusion:Autoimmune antibodies(ANA,SSA,SSB,JO-52)could be markers to evaluate NMOSD patients' prognosis.
引文
[1]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.
[2]WINGERCHUK D M,LENNON V A,LUCCHINETTI C F,et al.The spectrum of neuromyelitis optica[J].Lancet Neurology,2007(6):805-815.
[3]PITTOCK S J,LENNON V A,DE SEZE J,et al.Neuromyelitis optica and non organ-specific autoimmunity[J].Archives of Neurology,2008,65(1):78-83.
[4]ZHANG B,ZHONG Y,WANG Y,et al.Neuromyelitis optica spectrum disorders without and with autoimmune diseases[J].BMC Neurology,2014,14(1):162.
[5]IYER A,ELSONE L,APPLETON R,JACOB A.A review of the current literature and a guide to the early diagnosis of autoimmune disorders associated with neuromyelitis optica[J].Autoimmunity,2014,47(3):154-161.
[6]WANDINGER K P,STANGEL M,WITTE T,et al.Autoantibodies against aquaporin-4 in patients with neuropsychiatric systemic lupus erythematosus and primary Sjogren's syndrome[J].Arthritis and Rheumatism,2010,62(4):1198-1200.
[7]ESTIASARI R,MATSUSHITA T,MASAKI K,et al.Comparison of clinical,immunological and neuroimaging features between anti-aquaporin-4antibody-positive and antibody-negative Sjogren's syndrome patients with central nervous system manifestations[J].Multiple Sclerosis(Houndmills,Basingstoke,England),2012,18(6):807-816.
[8]BIRNBAUM J,ATRI N M,BAER A N,et al.Relationship between neuromyelitis optica spectrum disorder and Sjogren's syndrome:central nervous system extraglandular disease or unrelated,co-occurring autoimmunity?[J].Arthritis Care&Research,2017(69):1069-1075.
[9]黄鑫.视神经脊髓炎谱系疾病复发相关因素的临床研究[J].中风与神经疾病杂志,2016,33(5):433-437.
[10]杨扬.水通道蛋白4抗体对中枢神经炎性脱髓鞘疾病诊断及复发的预测价值[J].中华医学杂志,2012,92(43):3032-3035.
[11]MAVRAGANI C P,MOUTSOPOULOS H M.Sjogren's syndrome[J].Annual Review of Pathology,2014(9):273-285.
[12]JIN L,YU D,LI X,et al.CD4+CXCR5+follicular helper T cells in salivary gland promote B cells maturation in patients with primary Sjogren's syndrome[J].International Journal of Clinical and Experimental Pathology,2014,7(5):1988-1996.
[13]WINGERCHUK D M,WEINSHENKER B G.The emerging relationship between neuromyelitis optica and systemic rheumatologic autoimmune disease[J].Multiple Sclerosis(Houndmills,Basingstoke,England),2012,18(1):5-10.
[14]MADER S,GREDLER V,SCHANDA K,et al.Complement activating antibodies to myelin oligodendrocyte glycoprotein in neuromyelitis optica and related disorders[J].Journal of Neuroinflammation,2011,8(1):184.
[15]李昕頔.脑脊液MOG抗体阳性的视神经脊髓炎谱系疾病患者的临床特征[J].中国神经免疫学和神经病学杂志,2017,24(4):249-255.
[16]钟晓南.抗水通道蛋白4抗体阴性视神经脊髓炎/视神经脊髓炎谱系疾病的再认识[J].中华神经科杂志,2016,49(6):425-429.
[2]WINGERCHUK D M,LENNON V A,LUCCHINETTI C F,et al.The spectrum of neuromyelitis optica[J].Lancet Neurology,2007(6):805-815.
[3]PITTOCK S J,LENNON V A,DE SEZE J,et al.Neuromyelitis optica and non organ-specific autoimmunity[J].Archives of Neurology,2008,65(1):78-83.
[4]ZHANG B,ZHONG Y,WANG Y,et al.Neuromyelitis optica spectrum disorders without and with autoimmune diseases[J].BMC Neurology,2014,14(1):162.
[5]IYER A,ELSONE L,APPLETON R,JACOB A.A review of the current literature and a guide to the early diagnosis of autoimmune disorders associated with neuromyelitis optica[J].Autoimmunity,2014,47(3):154-161.
[6]WANDINGER K P,STANGEL M,WITTE T,et al.Autoantibodies against aquaporin-4 in patients with neuropsychiatric systemic lupus erythematosus and primary Sjogren's syndrome[J].Arthritis and Rheumatism,2010,62(4):1198-1200.
[7]ESTIASARI R,MATSUSHITA T,MASAKI K,et al.Comparison of clinical,immunological and neuroimaging features between anti-aquaporin-4antibody-positive and antibody-negative Sjogren's syndrome patients with central nervous system manifestations[J].Multiple Sclerosis(Houndmills,Basingstoke,England),2012,18(6):807-816.
[8]BIRNBAUM J,ATRI N M,BAER A N,et al.Relationship between neuromyelitis optica spectrum disorder and Sjogren's syndrome:central nervous system extraglandular disease or unrelated,co-occurring autoimmunity?[J].Arthritis Care&Research,2017(69):1069-1075.
[9]黄鑫.视神经脊髓炎谱系疾病复发相关因素的临床研究[J].中风与神经疾病杂志,2016,33(5):433-437.
[10]杨扬.水通道蛋白4抗体对中枢神经炎性脱髓鞘疾病诊断及复发的预测价值[J].中华医学杂志,2012,92(43):3032-3035.
[11]MAVRAGANI C P,MOUTSOPOULOS H M.Sjogren's syndrome[J].Annual Review of Pathology,2014(9):273-285.
[12]JIN L,YU D,LI X,et al.CD4+CXCR5+follicular helper T cells in salivary gland promote B cells maturation in patients with primary Sjogren's syndrome[J].International Journal of Clinical and Experimental Pathology,2014,7(5):1988-1996.
[13]WINGERCHUK D M,WEINSHENKER B G.The emerging relationship between neuromyelitis optica and systemic rheumatologic autoimmune disease[J].Multiple Sclerosis(Houndmills,Basingstoke,England),2012,18(1):5-10.
[14]MADER S,GREDLER V,SCHANDA K,et al.Complement activating antibodies to myelin oligodendrocyte glycoprotein in neuromyelitis optica and related disorders[J].Journal of Neuroinflammation,2011,8(1):184.
[15]李昕頔.脑脊液MOG抗体阳性的视神经脊髓炎谱系疾病患者的临床特征[J].中国神经免疫学和神经病学杂志,2017,24(4):249-255.
[16]钟晓南.抗水通道蛋白4抗体阴性视神经脊髓炎/视神经脊髓炎谱系疾病的再认识[J].中华神经科杂志,2016,49(6):425-429.