AQP4-IgG阳性视神经脊髓炎谱系疾病的r脑脊液细胞学特点

摘要

目的 探讨水通道蛋白4抗体(AQP4-IgG)阳性的视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)的脑脊液细胞学特点.方法 回顾性收集AQP4-IgG阳性的NMOSD患者的脑脊液细胞学、脑脊液常规、生化及寡克隆区带结果 ,并分析其特点.结果共收集237例A Q P4-Ig G阳性的NM OSD患者的脑脊液细胞学资料.女:男=7.8:1.120例(50.6％)患者脑脊液细胞学可见炎性反应,炎性反应程度为轻、中、重度者分别为63、43、14例.95例为淋巴细胞性炎性反应,20例为淋巴细胞与中性粒细胞性炎性反应,4例为淋巴细胞与嗜酸性粒细胞性炎性反应,1例为淋巴细胞、中性粒细胞与嗜酸性粒细胞性炎性反应.71例(30.0％)患者可见激活淋巴细胞,11例(4.6％)可见激活单核细胞,15例(6.3％)可见浆细胞.176例患者行寡克隆区带检测,其中脑脊液特异性寡克隆区带阳性47例(26.7％).结论 达1/2的AQP4-IgG阳性NM OSD患者脑脊液细胞学可见炎性反应,以淋巴细胞性炎性反应为主,也可见中性粒细胞与嗜酸性粒细胞参与;部分患者脑脊液细胞学可见激活淋巴细胞、激活单核细胞和浆细胞;AQP4-IgG阳性NMOSD患者脑脊液特异性寡克隆区带阳性率较多发性硬化低.上述脑脊液特点有助于NMOSD的诊断和鉴别.%Objective To explore the characteristics of the cerebrospinal fluid (CSF) cytology in AQP4-IgG positive neuromyelitis optica spectrum disorders (NMOSD) . Methods We retrospectively collected the CSF results of patients with NMOSD who were serum AQP4-IgG positive ,and analyzed the characteristics of the CSF cytology and other CSF results of these patients. Results The CSF cytology data of 237 patients with AQP4-IgG positive NMOSD were collected. Female:male ratio= 7.8:1. Visible inflammation was seen in 120 (50.6％ ) patients' CSF cytology :63 cases with mild inflammatory reaction ,43 cases with moderate inflammation and 14 cases with severe inflammation. For inflammation types , 95/20/4 cases were classified to lymphocytic inflammation/ lymphocytic and neutrophilic inflammation/ lymphocytic and eosinophilic inflammation respectively , while only 1 patients was classified to lymphocytic , neutrophilic and eosinophilic inflammation. Activated lymphocytes were seen in 71 (30.0％ ) patients while activated mononuclear cells in 11 (4.6％ ) cases and plasma cells in 15 (6.3％ ) cases. Oligoclonal bands were detected in 176 of all the patients ,and the specific oligoclonal band in CSF was positive in 47 cases. The positive rate was 26.7％ . Conclusions Inflammatory reaction was observed in about half of the AQP4-Ig G positive NMOSD patients' CSF cytology , and the main inflammatory types was lymphocytic inflammation while neutrophils and eosinophils were also seen in a few patients. Activated lymphocytes , activated mononuclear cells , and plasma cells could be detected in some patients'CSF. The positive rate of the specific oligoclonal band in AQP4-Ig G positive NMOSD was lower than that in multiple sclerosis. These CSF characteristics may contribute to the diagnosis and antidiastole of NMOSD.