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首页> 中文期刊> 《中国神经免疫学和神经病学杂志》 >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

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

         
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Objctive This study aimed to describe the clinical features of NMOSD patients with anti-MOG-antibodies to assist differential diagnoses in clinical practice.Methods Data including the patients'' clinical information and image findings from 32 patients with MS or NMOSD were collected and analyzed retrospectively.An enzyme linked immunosorbent assay was performed to detect the MOG antibodies in CSF.Cell based assays were used to detect AQP4 antibodies in the serum.Results Totally 29 NMOSD patients including 11 with AQP4 antibodies and 8 with MOG antibodies were enrolled.4 (36.4%) AQP4 antibodies positive and 5 (62.5%) MOG antibodies positive NMOSD patients (excluding patients with both positive MOG-Abs and AQP4-Abs), as well as 1(7.7%)MS patient presented with myelitis and optic neuritis.The median Expanded Disability Status Scale (EDSS) score of NMOSD patients with MOG antibodies was 3.50 (2.50, 4.00), which was lower than the AQP4 antibodies positive group during the remission stage [4.00(3.50,6.00),Z=-2.379,P=0.020].About 50% of MOG-Ab positive NMOSD patients had multiple lesions in the spinal cord, while all AQP4-Ab positive NMOSD patients had one lesion in the spinal cord (Z=6.967,P=0.018).The medium length of the spinal cord lesions in the AQP4-Ab positive group was 3(2,3), which was shorter than the AQP4-Ab positive group[4(3,5),Z=-2.499,P=0.012], and longer than the MS group [1.25(1,1.5),Z=-3.447,P<0.001].62.5% of the NMOSD patients with positive MOG-Ab had brain lesions, 3 of which were presented with NMOSD-like lesions, others were presented with MS-like lesions.Conclusions MOG-Ab positive NMOSD patients always combined with ON, lower EDSS and better prognosis.The spinal cord lesions in MOG-Ab positive NMOSD patients were multiple longitudinally extensive lesions.But the brain lesions lack specificity for differential diagnosis.%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(χ2=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(χ2=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.

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