血清抗核抗体、可提取性核抗原、抗中性粒细胞胞质抗体对视神经脊髓炎临床特点及急性复发期脑脊液特征的影响

摘要

Objective To explore the effect of antinuclear antibody ( ANA+dsDNA),extractable nuclear antigen (ENA) and antineutrophil cytoplasmic antibody (ANCA) on the clinical manifestation and cerebrospinal fluid characteristics of neuromyelitis optica (NMO).Methods All 41 patients with NMO in PUMC hospital from 1985 to 2009 were retrospectively reviewed.All patients underwent examination of serum ANA+dsDNA,ENA and ANCA.Fourteen positive-autoantibody patients were compared with 27negative-autoantibody patients in gender,onset age,duration,relapse ratio,first demyelination event,the extent of optic neuritis and myelitis,EDSS,CSF protein,WBC,Oligoclonal band, 24 hours IgG index and myelin basic protein.Results The 14 NMO patients (34.1%) had positive non-organ-specific antibodies.NMO patients who had negative autoantibodies were compared with NMO patients with positive autoantibodies with significantly higher EDSS (the EDSS score were 4.5 and 2.5 respectively,U=92.5,P=0.008),more complete damage of spinal cord (3/14 vs 0/27, x2=6.736, P=0.0095) and tended to have higher visual Function Scale in remitting phase.There was no significant difference on the gender,onset age,duration,relapse ratio,first demyelination event.The positive-autoantibody patients had higher CSF WBC (2.0 vs 0,U=68.0,P=0.007) and tended to have lower 24 hours IgG index (-8.663 vs 0.163,U=30.0,P=0.053).There was no significant difference in CSF protein,MBP and OB.Conclusion NMO patients with positive autoantibodies have more severe intrathecal autoimmune inflammatory and disability,so they might need more intensive treatment.%目的 探讨血清抗核抗体(ANA+dsDNA)、可提取性核抗原(ENA)、抗中性粒细胞胞质抗体(ANCA)对视神经脊髓炎(NMO)临床特点及急性复发期脑脊液特征的影响.方法 回顾分析1985-2009年北京协和医院收治的临床诊断为NMO的41例患者,均进行血清ANA+dsDNA、ENA和ANCA检查,比较其中14例自身抗体阳性的NMO患者与27例自身抗体阴性的患者的临床特征及急性复发期脑脊液检查结果.结果 14例(34.1%)NMO患者自身抗体阳性,与自身抗体阴性的NM0患者相比,缓解期最高的视力评分(M50,自身抗体阳性组5分,自身抗体阴性组2分)及最差视力低于眼前数指的比例(分别为42.9%和16.0%)有升高的趋势,但差异无统计学意义;自身抗体阳性组缓解期扩展神经功能缺失状况评分(EDSS,4.5)较自身抗体阴性组(2.5)明显增高(U=92.5,P=0.008),并且容易出现脊髓横断性损害(分别为3/14、0/27,x2=6.736,P=0.009),而性别、起病年龄、病程、年复发率、首发部位在2组间差异无统计学意义.2组患者急性复发期脑脊液检查结果比较,自身抗体阳性患者脑脊液白细胞数(2.0)明显升高(U=68.0,P=0.007),24 h IgG合成率有减低的趋势(分别为-8.663、0.163),但差异无统计学意义(U=30.0,P=0.053),而脑脊液蛋白、髓鞘碱性蛋白、寡克隆区带差异无统计学意义.结论合并ANA、ENA、ANCA阳性NMO患者鞘内免疫炎性反应严重,神经功能缺失较重,可能需要强化免疫治疗.