Objective To assess the seroprevalence and diagnostic value of aquaporin-4 antibody (AQP4-Ab) in patients with inflammatory central nervous system demyelinating diseases. Methods Seventy-two patients with neuromyelitis optica (NMO), 68 with multiple sclerosis (MS), 4 with optic neuritis (ON), and 41 with transverse myelitis (TM) were included in this study. The TM group comprised 19 patients with non-longitudinally extensive transverse myelitis (nLETM), 14 with monophasic longitudinally extensive transverse myelitis (mLETM), and 8 with recurrent longitudinally extensive transverse myelitis (rLETM). The serum levels of AQP4-Ab was detected by indirect immunofluorence assay in these patients. Results AQP4-Ab was detected in 72.2% (52/72) patients with NMO, 5.9% (4/ 68) patients with MS, 25.0% (1/4) patients with ON, and 17.1% (7/41) patients with TM, showing a significant difference in the positivity between NMO and MS groups (P<0.01). AQP4-Ab seropositivity rate was 5.3% (1/19) in nLETM patients, 62.5% (5/8) in rLETM patients and 7.1% (1/14) in mLETM patients, significantly higher in rLETM than in nLETM (P＜0.01) and mLETM groups (P<0.05), but no statistical difference was found between rLETM and NMO groups. Conclusions A high seroprevalence of AQP4-Ab is observed in patients with NMO and rLETM, which support the hypothesis that NMO and rLETM belong to NMO spectrum disorders. AQP4-Ab can serve as a useful index for diagnosing NMO and differential diagnosis from MS. More attention and effective immunosuppressive treatments should be given to patients positive for AQP4-Ab.%目的 研究中枢神经脱髓鞘疾病患者血清水通道蛋白4抗体(AQP4-Ab)阳性率,并探讨其临床意义.方法 采集2008年11月至2010年10月间就诊于我院神经内科门诊和病房的185例中枢神经系统脱髓鞘疾病患者血清,其中视神经脊髓炎(NMO)72例,多发性硬化(MS)68例,视神经炎(ON)4例,横贯性脊髓炎(TM)41例;后者包括非长节段横贯性脊髓炎(nLETM)19例,单次发作长节段横贯性脊髓炎(mLETM)14例,复发长节段横贯性脊髓炎(rLETM)8例.采用细胞间接免疫荧光技术检测患者血清AQP4-Ab,统计其阳性率并进行分析.结果 AQP4-Ab在NMO、MS、ON、TM组的阳性率分别为72.2%(52/72)、5.9%(4/68)、25.0%(1/4)、17.1%(7/41),NMO组显著高于MS组(P＜0.01);nLETM、rLETM和mLETM组AQP4-Ab阳性率分别为5.3%(1/19)、62.5%(5/8)和7.1%(1/14),rLETM组显著高于nLETM组(P＜0.01)和mLETM组(P＜0.05).rLETM和NMO组间AQP4-Ab阳性率差异无统计学意义(P＞0.05).结论 AQP4-Ab在NMO和rLETM患者血清阳性率高,支持两者同属于视神经脊髓炎谱系疾病;AQP4-Ab可以作为诊断NMO并与MS相鉴别的重要指标,对于AQP4-Ab阳性患者应给予高度关注和更为积极的免疫抑制治疗.
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