临床孤立综合征转归为视神经脊髓炎的相关因素分析Correlative factor analysis for clinically isolated syndrome turning to neuromyelitis optica
郭海霞;张美妮;郝洪军;
摘要(Abstract):
目的探讨临床孤立综合征(CIS)转归为视神经脊髓炎(NMO)的影响因素。方法收集2004-09-2011-09就诊于作者医院神经内科CIS患者109例。回顾性分析所有患者首次发病时头颅和脊髓MRI特点及临床表现。采用酶联免疫吸附法(ELISA)检测血清水通道蛋白4抗体(AQP4-Ab)水平,另备30份健康者血清作为健康对照组,以高于健康对照组血清AQP4-Ab浓度的均值+3倍标准差者为阳性。结果 (1)随访0.5~7年,中位数为3.0年,四分位数间距为4.6年,转归为NMO 46例,转归为多发性硬化(MS)29例,其余仍是CIS,包括24例脊髓炎,10例视神经炎(ON)。(2)转归为NMO组血清AQP4-Ab水平明显高于MS组、脊髓炎组、ON组和健康对照组(P<0.05)。(3)转归为NMO组AQP4-Ab阳性率为63.03%(29/46),高于转归为MS组的13.79%(4/29)、脊髓炎组的29.17%(7/24)、ON组的20.00%(2/10),差异均有统计学意义(P<0.05)。(4)多因素分析结果提示:AQP4-Ab阳性、NMO颅内典型病灶、脊髓损伤>3个节段、扩展残疾状态量表(EDSS)与CIS转归为NMO有关。结论 AQP4-Ab阳性、NMO颅内典型病灶或者脊髓损伤>3个节段、EDSS评分对预测CIS转归为NMO有临床价值。
关键词(KeyWords): 临床孤立综合征;转归;视神经脊髓炎;因素分析,统计学
基金项目(Foundation): 山西省回国留学人员科研资助项目(2011-101)
作者(Author): 郭海霞;张美妮;郝洪军;
Email:
DOI:
参考文献(References):
- [1]Kikuchi S,Fukazawa T.OSMS is NMO,but not MS:con-firmed by NMO-IgG[J].Lancet Neurol,2006,5(2):110-111.
- [2]Wingerchuk DM,Lennon VA,Pittock SJ,et al.Revised diag-nostic criteria for neuromyelitis optica[J].Neurology,2006,66(10):1485-1489.
- [3]Rubiera M,Río J,TintoréM,et al.Neuromyelitis optica di-agnosis in clinically isolated syndromes suggestive of multiplesclerosis[J].Neurology,2006,66:1568-1570.
- [4]McDonald WI,Compston A,Edan G,et al.Recommendeddiagnostic criteria for multiple sclerosis:guidelines from theInternational Panel on the diagnosis of multiple sclerosis[J].Ann Neurol,2001,50(1):121-127.
- [5]Lennon VA,Kryzer TJ,Pittock SJ,et al.IgG marker of op-tic-spinal multiple sclerosis binds to the aquaporin-4 waterchannel[J].Exp Med,2005,202(4):473-477.
- [6]Yamanoto N,Yoneda K,Asai K,et al.Alteration in the ex-pression of the AQP family incultured rat astrocytes duringhypoxia and reoxygenation[J].Brain Res Mol Brain Res,2001,90:26-38.
- [7]Wingerehuk DM.Neuromyelifis optica:new findings onpatho-genesis[J].Int Rev Neurobiol,2007,79:665-688.
- [8]Kinoshita M,Nakatsuji Y,Kimura T,et al.Neuromyelitis op-tica:Passive transfer to rats by human immunoglobulin[J].Biochem Biophys Res Commun,2009,386(4):623-627.
- [9]Cabrera-Gomez JA,Kurtzke JF,Gonzalez-Quevedo A,et al.An epidemiological study of neuromyelitis optica in Cuba[J].JNeurol,2009,256:35-44.
- [10]Kim JE,Kim SM,Ahn SW,et al.Brain abnormalities in neu-romyelitis optica[J].J Neurol Sci,2011,302:43-48.
- [11]Pittock SJ,Lennon VA,Krecke K,et al.Brain abnormali-ties neuromyelitis in optica[J].Arch Neurol,2006,63:390-396.