血清髓鞘少突胶质细胞糖蛋白抗体或水通道蛋白4抗体阳性的成人视神经炎患者的临床特征

Q4 Medicine

中华眼底病杂志 Pub Date : 2019-09-25 DOI:10.3760/CMA.J.ISSN.1005-1015.2019.05.008

H. Qiu, Hongjuan Liu, Kan-Hung Cheng, Quangang Xu, Hao Kang, Honglu Song, Huanfen Zhou, S. Wei

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The clinical features of optic neuritis (annual recurrence frequency, incidence of optic disc edema), brain and optic nerve enhanced MRI, serum autoimmune antibodies and cerebrospinal fluid test results were compared between MOG-ON and AQP4-ON patients. All patients were treated with intravenous methylprednisolone sodium succinate in the acute phase and then switched to oral prednisone acetate tablets. The average follow-up time was 15 months. The glucocorticoid dependence, visual prognosis, spinal cord symptoms, and myelitis at the last follow-up were comparatively analyzed between MOG-ON and AQP4-ON patients. 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引用次数: 0

摘要

目的分析血清髓鞘少突胶质细胞糖蛋白抗体（MOG-ON）或水通道蛋白4抗体（AQP4-ON）阳性的成人视神经炎患者的临床特点及预后。方法回顾性研究。2015年12月至2018年2月，在首都医科大学北京朝阳医院和中国人民解放军总医院，132名血清MOG抗体和AQP4阳性患者的162眼被纳入研究。MOG-ON患者42例（49眼，占31.8%），AQP4-ON患者90例（113眼，占68.2%），比较了MOG-ON和AQP4-ON患者视神经炎的临床特点（年复发率、视盘水肿发生率）、脑和视神经增强MRI、血清自身免疫抗体和脑脊液检查结果。所有患者在急性期均静脉注射甲基强的松龙琥珀酸钠，然后改用口服醋酸泼尼松片。平均随访时间为15个月。比较分析MOG-ON和AQP4-ON患者在最后一次随访时的糖皮质激素依赖性、视觉预后、脊髓症状和脊髓炎。计数数据采用χ2检验进行比较，测量数据采用t检验进行比较。结果与AQP4-ON患者相比，MOG-ON患者的年复发率较高（t=3.760，P=0.005），视盘水肿发生率较高（χ2=14.777，P<0.001），激素依赖发生率较高（χ2=25.496，P<0.001，AQP4-ON患者更可能涉及视交叉和视束。MOG-ON和AQP4-ON患者病变部位差异有统计学意义（χ2=5.447，P=0.015）。AQP4-ON患者自身免疫抗体的比例显著高于MOG-ON患者（χ2=20.453，P<0.001）正常范围，但AQP4-ON患者的IgG水平明显高于MOG-ON患者（t=8.669，P<0.001）。最后一次随访时，MOG-ON和AQP4-ON患者分别有7例和29例脊髓炎患者（χ2=3.494，P=0.046）。视盘水肿的发生率和复发率较高，但自身免疫抗体的比例较低。MOG-ON更可能表现出激素依赖，但视觉预后更好。AQP4-ON易累及视交叉和视束，脊髓炎发生率较高。关键词：视神经炎；少突胶质细胞；水通道蛋白4；疾病属性；预后

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Clinical characteristics of adult optic neuritis patients with positive serum myelin oligodendrocyte glycoprotein antibody or aquaporin 4 antibody

Objective To analyze the clinical features and prognosis of adult optic neuritis patients with positive serum myelin oligodendrocyte glycoprotein antibody (MOG-ON) or aquaporin 4 antibody (AQP4- ON). Methods A retrospective study. From December 2015 to February 2018, in the Beijing Chaoyang Hospital of Capital Medical University and Chinese PLA General Hospital, 162 eyes of 132 patients with positive serum MOG antibody and AQP4 were included in the study. There were 42 MOG-ON patients (49 eyes, 31.8%), 90 AQP4-ON patients (113 eyes, 68.2%). The clinical features of optic neuritis (annual recurrence frequency, incidence of optic disc edema), brain and optic nerve enhanced MRI, serum autoimmune antibodies and cerebrospinal fluid test results were compared between MOG-ON and AQP4-ON patients. All patients were treated with intravenous methylprednisolone sodium succinate in the acute phase and then switched to oral prednisone acetate tablets. The average follow-up time was 15 months. The glucocorticoid dependence, visual prognosis, spinal cord symptoms, and myelitis at the last follow-up were comparatively analyzed between MOG-ON and AQP4-ON patients. The comparison of the count data was performed by χ2 test, and the measurement data were compared by t test. Results Compared with AQP4-ON patients, MOG-ON patients had higher annual recurrence frequency (t=3.760, P=0.005), higher incidence of optic disc edema (χ2=14.777, P<0.001), higher incidence of hormone dependence (χ2=25.496, P<0.001), and better visual prognosis (χ2=28.759, P<0.001). MOG-ON patients were more likely to involve the optic nerve, AQP4-ON patients were more likely to involve the optic chiasm and the optic tract. There was a significant difference in the location of lesions between MOG-ON and AQP4-ON patients (χ2= 5.447, P= 0.015). The proportion of AQP4-ON patients with autoimmune antibodies was significantly higher than that of MOG-ON patients (χ2 = 20.453, P<0.001). The results of cerebrospinal fluid test showed that the white blood cell count of patients with MOG-ON and AQP4- ON were within the normal range, but the IgG level of AQP4-ON patients was significantly higher than that of MOG-ON patients (t=8.669, P<0.001). At the last follow-up, there were 7 and 29 patients of myelitis in MOG-ON and AQP4-ON patients respectively (χ2=3.494, P=0.046). Conclusions The clinical characteristics of MOG-ON were different from AQP4-ON. The incidence of optic disc edema and recurrence rate were higher, but the proportion of autoimmune antibodies was lower. MOG-ON was more likely to show hormone dependence, but the visual prognosis was better. AQP4-ON was easily involved in optic chiasm and optic tract, and the incidence of myelitis was higher. Key words: Optic neuritis; Oligodendroglia; Aquaporin 4; Disease attributes; Prognosis

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来源期刊

中华眼底病杂志 Medicine-Ophthalmology

CiteScore

0.40

自引率

0.00%

发文量

5383

期刊介绍： Chinese Journal of Ocular Fundus Diseases is the only scientific journal in my country that focuses on reporting fundus diseases. Its purpose is to combine clinical and basic research, and to give equal importance to improvement and popularization. It comprehensively reflects the leading clinical and basic research results of fundus disease disciplines in my country; cultivates professional talents in fundus disease, promotes the development of fundus disease disciplines in my country; and promotes academic exchanges on fundus disease at home and abroad. The coverage includes clinical and basic research results of posterior segment diseases such as retina, uveal tract, vitreous body, visual pathway, and internal eye diseases related to systemic diseases. The readers are medical workers and researchers related to clinical and basic research of fundus diseases. According to the journal retrieval report of the Chinese Institute of Scientific and Technological Information, the comprehensive ranking impact factor and total citation frequency of the Chinese Journal of Ocular Fundus Diseases have been among the best in the disciplines of ophthalmology, otolaryngology, and ophthalmology in my country for many years. The papers published have been included in many important databases at home and abroad, such as Scopus, Peking University Core, and China Science Citation Database (CSCD).