中华眼底病杂志

中华眼底病杂志

视力损伤严重的视神经脊髓炎谱系疾病患者病情及视力预后与水通道蛋白4抗体的相关性研究

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目的 观察视力损伤严重的视神经脊髓炎谱系疾病(NMOSD)患者病情及视力预后与水通道蛋白4(AQP4)抗体的相关性。 方法 回顾性分析研究。临床确诊为视力损伤严重的50例NMOSD患者纳入研究。患者至少1只眼视力≤20/200。其中,男性12例,女性38例;年龄17~65岁,平均年龄为(39.86±2.02)岁。所有患者均行血清AQP4抗体检测,根据检测结果将其分为阳性组、阴性组。对比分析两组患者的眼科相关检查、血清抗核抗体(ANA)和髓鞘少突胶质细胞糖蛋白(MOG)抗体检测及视力预后情况。对于发病1个月内的46例患者进行糖皮质激素治疗。将患者治疗后视力分为完全恢复、部分恢复、不变及下降4种情况,对比分析两组患者的视力预后。 结果 50例患者中,AQP4抗体阳性(阳性组)30例,占60%;AQP4抗体阴性(阴性组)20例,占40%。与阴性组比较,阳性组女:男比例更高,双眼视神经炎(ON)例数更多,差异均有统计学意义(P=0.004、0.010)。复发性ON更常见于阳性组患者,但两组复发性ON例数比较,差异无统计学意义(P=0.167)。两组患者发病年龄、病程、视力损害程度最低评分以及眼眶MRI异常例数比较,差异均无统计学意义(P>0.05)。阳性组24例患者行ANA检测,其中8例为阳性。阴性组18例患者行ANA检测,均为阴性。两组患者ANA检测结果比较,差异有统计学意义(P=0.030)。阳性组10例患者行MOG抗体检测,均为阴性。阴性组16例患者行MOG抗体检测,其中4例为阳性。两组患者MOG抗体检测结果比较,差异无统计学意义(P=0.092)。阳性组患者经治疗后视力完全恢复、部分恢复、不变及下降占比分别为23.3%、23.3%、0.0%、53.3%;阴性组患者经治疗后视力完全恢复、部分恢复、不变及下降占比分别为25.0%、30.0%、20.0%、25.0%。两组患者经治疗后视力完全恢复、部分恢复例数比较,差异均无统计学意义(P=0.163、0.607);视力不变、下降例数比较,差异有统计学意义(P=0.021、0.048)。 结论 AQP4抗体阳性在视力损伤严重的NMOSD患者中更常见。AQP4抗体阳性者较阴性者更易合并免疫血清学标记物,且视力预后更差。

Objective To observe the correlation of serum aquaporin 4 (AQP4) antibodies and condition and visual prognosis in patients with severe neuromyelitis optica spectral disorders (NMOSD). Methods Fifty NMOSD patients with visual acuity of 20/200 or worse in at least one eye were enrolled in this retrospective analysis. There were 12 males and 38 females. The age ranged from 17 to 65 years, with the mean of (39.86±2.02) years. The patients were divided into two groups according to the serum AQP4-IgG status. The ophthalmologic examination, serum anti-nuclear antibodies (ANA), myelin oligodendrocyte glycoprotein (MOG) antibody detection and vision prognosis were compared and analyzed. Glucocorticoid therapy was delivered to 46 patients who were within 1 month of onset. The visual acuity of the patients after treatment was divided into complete recovery, partial recovery, stabilization and reduction, and the visual acuity of the two groups were analyzed. Results Among 50 patients, there were 30 (60%) seropositive patients (positive group), 20 (40%) seronegative patients (negative group). The positive group had significantly higher ratio of female to male (P=0.004), and more binocular optic neuritis (ON) (P=0.010) compared with the negative group. More recurrence ON were also found in the positive group, but without statistic difference between two groups (P=0.167). There was no difference of age, course, and vision damage degrees and abnormal orbital MRI scanning between two groups (P>0.05). Among 24 patients who underwent serum ANA detection in the positive group, 8 patients were positive. All of 18 patients who underwent serum ANA detection in the negative group were negative. The difference of the ratio of serum ANA positive patients between two groups was significant (P=0.030). Serum MOG antibody detection in the positive group was negative (0/10). Sixteen patients who underwent MOG antibody detection in negative group, 4 patients were positive. After treatment, there were 23.3%, 23.3%, 53.3% patients with vision of complete recovery, partial recovery and reduction in the positive group; 25.0%, 30.0%, 25.0% patients with vision of complete recovery, partial recovery and reduction in the negative group, respectively. There was no difference in proportion of vision with complete recovery and partial recovery between two groups (P=0.163, 0.607), but significant difference was observed in proportion of vision with stabilization and reduction between two groups (P=0.021, 0.048). Conclusions The positive serum AQP4 antibody is common in patients with severe NMOSD. The patients with AQP4 antibody in the serum are more likely combined with immunological serological markers and poor vision prognosis.

关键词: 视神经脊髓炎; 视力损伤者; 水通道蛋白质4

Key words: Neuromyelitis optica; Visually impaired persons; Aquaporin 4

引用本文: 曹珊珊, 李红阳, 彭春霞, 魏世辉. 视力损伤严重的视神经脊髓炎谱系疾病患者病情及视力预后与水通道蛋白4抗体的相关性研究. 中华眼底病杂志, 2017, 33(5): 467-471. doi: 10.3760/cma.j.issn.1005-1015.2017.05.007 复制

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