李昕頔;王化冰;周衡;周安娜;刘永红;赵琳;张星虎;

• 1:首都医科大学附属北京天坛医院神经病学中心神经感染免疫科

摘要(Abstract)：

目的探讨MOG抗体阳性的NMOSD患者的临床特点。方法选择29例NMOSD患者,根据血清AQP-4抗体以及脑脊液MOG抗体检测结果,分为MOG抗体阳性、AQP4抗体阳性的NMOSD(剔除双阳性者),同时选择13例MS患者作为对照。回顾性分析上述三组患者临床信息,统计归纳其临床特点。结果 29例NMOSD患者中血清AQP4抗体阳性者11例,脑脊液MOG抗体阳性者8例。36.4%(4例/11例)AQP4抗体阳性、62.5%(5例/8例)MOG抗体阳性NMOSD患者,以及7.7%(1例/13例)MS患者合并脊髓炎与视神经炎,三组间差异有统计学意义(χ~2=7.128,P=0.028),其中MOG抗体阳性NMOSD患者较MS患者更易合并视神经炎(χ~2=7.289,P=0.014)。MOG抗体阳性NMOSD患者缓解期EDSS分数低于AQP4抗体阳性NMOSD患者[3.50(2.50,4.00),4.00(3.50,6.00),Z=-2.379,P=0.020]。MOG抗体阳性NMOSD脊髓病灶多表现为多发的长节段脊髓病灶,50%(4例/8例)MOG抗体阳性脊髓病灶个数大于1个,与MS组无明显差异,而AQP4抗体阳性组均为单个病灶。MOG抗体阳性NMOSD脊髓病灶长度较AQP4抗体阳性组短[分别(3(2,3)个椎体、4(3,5)个椎体,Z=-2.499,P=0.012],较MS组[(1.25(1,1.5)个椎体]长(Z=-3.447,P<0.001)。8例MOG抗体阳性患者中5例存在颅内病灶,3例表现为NMOSD样颅内病灶,余2例表现为MS样颅内病灶,其病灶形态及部位与AQP4抗体阳性组无明显差异,而与MS组存在差异。结论 MOG抗体阳性NMOSD合并视神经炎的患者较多,临床残障程度较轻,预后较好,脊髓病灶为多发的长节段脊髓病灶;颅内病灶的形态及部位与MS无明显差异。

关键词(KeyWords)： 视神经脊髓炎谱系疾病;多发性硬化;水通道蛋白4抗体;髓鞘少突胶质细胞糖蛋白抗体;磁共振波谱学

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李昕頔;王化冰;周衡;周安娜;刘永红;赵琳;张星虎;

Email:

DOI:

参考文献(References)：

• [1]Lennon VA,Wingerchuk DM,Kryzer TJ,et al.A serum autoantibody marker of neuromyelitis optica:distinction from multiple sclerosis[J].Lancet,2004,364(9451):2106-2112.
• [2]Wingerchuk DM,Lennon VA,Lucchinetti CF,et al.The spectrum of neuromyelitis optica[J].Lancet Neurol,2007,6(9):805-815.
• [3]Wingerchuk DM,Banwell B,Bennett JL,et al.International consensus diagnostic criteria for neuromyelitis optica spectrum disorders[J].Neurology,2015,85(2):177-189.
• [4]Zadro I,Brinar V,Horvat G,et al.Clinical relevance of antibodies against myelin oligodendrocyte glycoprotein in different clinical types of multiple sclerosis[J].Clin Neurol Neurosurg,2007,109(1):23-26.
• [5]van Pelt ED,Wong YY,Ketelslegers IA,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.
• [6]Yamout B,Alroughani R,Al-Jumah M,et al.Consensus guidelines for the diagnosis and treatment of multiple sclerosis[J].Curr Med Res Opin,2013,29(6):611-621.
• [7]Yang CS,Zhang DQ,Wang JH,et al.Clinical features and sera anti-aquaporin 4 antibody positivity in patients with demyelinating disorders of the central nervous system from Tianjin,China[J].CNS Neurosci Ther,2014,20(1):32-39.
• [8]Sato DK,Callegaro D,Lana-Peixoto MA,et al:Distinction between MOG antibody-positive and AQP4antibody-positive NMO spectrum disorders[J].Neurology,2014,82(6):474-481.
• [9]Ramanathan S,Reddel SW,Henderson A,et al:Antibodies to myelin oligodendrocyte glycoprotein in bilateral and recurrent optic neuritis[J].Neurol Neuroimmunol Neuroinflamm,2014,1(4):e40.
• [10]Cobo-Calvo A,Sepulveda M,Bernard-Valnet R,et al.Antibodies to myelin oligodendrocyte glycoprotein in aquaporin 4antibody seronegative longitudinally extensive transverse myelitis:Clinical and prognostic implications[J].Mult Scler,2016,22(3):312-319.
• [11]Saadoun S,Waters P,Owens GP,et al.Neuromyelitis optica MOG-IgG causes reversible lesions in mouse brain[J].Acta Neuropathol Commun,2014,2:35.
• [12]Asavapanumas N,Ratelade J,Verkman AS,et al.Unique neuromyelitis optica pathology produced in naive rats by intracerebral administration of NMO-IgG[J].Acta Neuropathol,2014,127(4):539-551.
• [13]Jarius S,Ruprecht K,Kleiter I,et al.MOG-IgG in NMO and related disorders:a multicenter study of 50patients.Part 2:Epidemiology,clinical presentation,radiological and laboratory features,treatment responses,and long-term outcome[J].J Neuroinflammation,2016,13(1):280.
• [14]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):1270-1281.
• [15]Kim HJ,Paul F,Lana-Peixoto MA,et al.MRI characteristics of neuromyelitis optica spectrum disorder:an international update[J].Neurology,2015,84(11):1165-1173.
• [16]Jarius S,Kleiter I,Ruprecht K,et al.MOG-IgG in NMO and related disorders:a multicenter study of 50patients.Part 3:Brainstem involvement-frequency,presentation and outcome[J].J Neuroinflammation,2016,13(1):281.