临床孤立综合征转归为视神经脊髓炎的相关因素分析

摘要

目的 探讨临床孤立综合征(CIS)转归为视神经脊髓炎(NMO)的影响因素.方法 收集2004-09-2011-09就诊于作者医院神经内科CIS患者109例.回顾性分析所有患者首次发病时头颅和脊髓MRI特点及临床表现.采用酶联免疫吸附法(ELISA)检测血清水通道蛋白4抗体(AQP4-Ab)水平,另备30份健康者血清作为健康对照组,以高于健康对照组血清AQP4-Ab浓度的均值+3倍标准差者为阳性.结果 (1)随访0.5～7年,中位数为3.0年,四分位数间距为4.6年,转归为NMO 46例,转归为多发性硬化(MS)29例,其余仍是CIS,包括24例脊髓炎,10例视神经炎(ON).(2)转归为NMO组血清AQP4-Ab水平明显高于MS组、脊髓炎组、ON组和健康对照组(P＜0.05).(3)转归为NMO组AQP4-Ab阳性率为63.03％(29/46),高于转归为MS组的13.79％(4/29)、脊髓炎组的29.17％(7/24)、ON组的20.00％(2/10),差异均有统计学意义(P＜0.05).(4)多因素分析结果提示:AQP4-Ab阳性、NMO颅内典型病灶、脊髓损伤＞3个节段、扩展残疾状态量表(EDSS)与CIS转归为NMO有关.结论 AQP4-Ab阳性、NMO颅内典型病灶或者脊髓损伤＞3个节段、EDSS评分对预测CIS转归为NMO有临床价值.%Objective To explore influential factors for the evolution of clinically isolated syndrome (CIS) to optic nerve myelitis (NMO). Methods One hundred and nine patients with CIS were included in author' s hospital form Sep 2004 to Nov 2011. Brain and spinal cord MRI characteristics and clinical manifestations were retrospectively analyzed among all of the patients on the first attack. 30 healthy subjects were taken as normal controls and their serum were collected. Serum aquaporin-4 antibody (AQP4-Ab) level was detected with Enzyme-linked Immunosorbent Assay (ELISA). The serum AQP4-Ab level higher than the mean value of normal control group plus 3 times of standard deviation was regarded as positive. Results (1) All the patients were followed up for 0. 5 tp 7 years, with a median of 3. 0 years, and inter-quartile range of 4. 6 years. 46 and 29 CIS patients developed into NMO and MS, respectively, and the others were still classified as CIS including 24 with transverse myelitis (TM) and 10 with optic neuritis (ON). (2) The serum AQP4-Ab level in the NMO group was significantly higher than that in other groups (the MS group, the TM group and the ON group) and the normal control group (P＜ 0.05). (3) AQP4-Ab positive rate was 63.03% (29/46) in the NMO group, which was higher than that in the MS group (13. 79%, 4/29), the TM group (29.17%, 7/24), and the ON group (20.00%, 2/10), and the above differences were statistically significant (P ＜ 0. 05, respectively). (4) Multifactor analysis indicated that brain NMO typical lesions and longitudinal spjrial lesions, EDSS, serum AQP4-Ab positive were correlative factors of CIS turning to NMO. Conclusions AQP4-Ab positive, brain NMO typical lesions, typical spinal cord injury＞ 3 segments and EDSS are valuable to predict CIS turning to NMO.