中国西部地区脱髓鞘性视神经炎患者AQP4-IgG表达及其临床特征关系分析

Analysis of the relationship between AQP4-IgG expression and clinical characteristics in patients with demyelinated optic neuritis in western China

摘要:

目的 比较142例脱髓鞘性视神经炎（demyelinated optic neuritis，DON）患者血清或脑脊液中AQP4-IgG表达与其临床特征的关系。方法 回顾性收集2016年1月至2020年10月于陆军军医大学第一附属医院眼科收治的142例DON患者AQP4-IgG检验结果，对AQP4-IgG阳性及阴性患者的临床资料进行分析。结果 ①检测到AQP4-IgG阳性者48例（33.8%），女性与男性比为5.9∶1，双眼同时发病者31例（64.6%），发病时LogMAR视力为0.48±0.64，随访结束时LogMAR视力为0.55±0.65。②检测到AQP4-IgG阴性者94例（66.2%），女性与男性比为1.7∶1，双眼同时发病者53例（56.4%），发病时LogMAR视力为0.54±0.61，随访结束时LogMAR视力为0.39±0.49。③AQP4-IgG阳性女性患者比例明显高于AQP4-IgG阴性患者（χ2=7.827，P<0.01）；二者双眼患病率不具有统计学差异（χ2=0.884，P>0.05）；二者在发病时LogMAR视力并无统计学差异（t=-0.721，P>0.05），但AQP4-IgG阳性患者视力预后更差（t =2.058，P<0.05）。AQP4-IgG阳性患者血沉升高（χ2=5.403，P<0.05），以及合并自身抗体结果阳性的比例比AQP4-IgG阴性患者更高（χ2=5.231，P<0.05），二者均具有统计学差异。结论 AQP4-IgG阳性的视神经脊髓炎谱系疾病患者女性发病率更高，视力预后更差，且可能合并自身抗体结果异常或者自身免疫性疾病。根据AQP4-IgG检测结果，准确地进行临床分型对治疗方案选择及预后分析具有重要指导意义。

Abstract:

Objective To compare the relationship between AQP4-IgG expression and its clinical characteristics in the serum or cerebrospinal fluid of 142 patients with demyelinated optic neuritis（DON）.Methods We retrospectively collected and analyzed the clinical data and AQP4-IgG results of 142 DON patients admitted to the Department of Ophthalmology of The First Affiliated Hospital of Army Medical University from January 2016 to October 2020.Results ①AQP4-IgG positive was detected in 48 cases（33.8%），the female to male ratio was 5.9∶1，and 31 cases（64.6%） involved both eyes. The LogMAR visual acuity at the first visit was 0.48±0.64，and was 0.55±0.65 at the last visit. ②AQP4-IgG negative was detected in 94 cases（66.2%），the female to male ratio was 1.7∶1，and 53 cases（56.4%）involved both eyes. The LogMAR visual acuity at the first visit was 0.54±0.61，and was 0.39±0.49 at the last visit. ③The proportion of AQP4-IgG-positive female patients was significantly higher than that of AQP4-IgG-negative patients（χ2=7.827，P<0.01）； there was no statistical difference in the prevalence of both eyes（χ2=0.884，P>0.05）； there was no significant difference in LogMAR visual acuity at the time of onset（t=-0.721，P>0.05），but AQP4-IgG positive patients had worse visual prognosis（t=2.058，P<0.05）. AQP4-IgG positive patients had higher erythrocyte sedimentation rate（χ2=5.403，P<0.05）and a higher proportion of combined autoantibody results than AQP4-IgG negative patients（χ2=5.231，P<0.05），both of which had significant differences.Conclusion AQP4-IgG-positive patients with neuromyelitis optica spectrum disorders have a higher incidence of female morbidity，with worse visual prognosis，and may be combined with abnormal autoantibody results or autoimmune diseases. Accurate clinical classification based on AQP4-IgG detection is important for the treatment and prognosis.