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患有AQP4-IgG阳性NMOSD的患者无症状脊髓病变:现实世界队列研究

Shugang Cao^1,2, Yunfei Zhu³, Xiaosan Wu¹

¹Department of Neurology, Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China.

Annals of clinical and translational neurology

|February 4, 2024

概括

无症状脊椎病变 (ASL) 在AQP4-IgG阳性NMOSD患者中发现,特别是在常规免疫疗法下. 虽然ASL可能表明炎症,但它们并不能显著预测该队列的未来复发.

科学领域:

神经学神经学
免疫学免疫学免疫学
放射学放射学是一门学科.

背景情况:

神经脊髓炎光学谱系障碍 (NMOSD) 是一种影响中枢神经系统的自身免疫性疾病.
水蛋白-4免疫球蛋白G (AQP4-IgG) 血清阳性是NMOSD的一个关键诊断标志物.
无症状脊髓病变 (ASLs) 是NMOSD病理生理学的一个未被认可的方面.

研究的目的:

确定在AQP4-NMOSD患者中ASL的频率和影响因素.
评估ASL对AQP4-NMOSD后续复发风险的影响.
研究免疫疗法在ASL发展和复发风险中的作用.

主要方法:

来自129名AQP4-NMOSD患者的临床数据和脊柱MRI的回顾性审查.
在急性发作和缓解期期间获得的脊柱MRI的分析.
卡普兰-梅尔曲线和考克斯比例危险模型用于评估ASL和复发风险的预测因素.

主要成果:

在发作期间3.5%的脊柱MRI和在缓解期间9%的脊柱MRI中发现了ASL.
缓解ASL与常规免疫抑制剂有关,但与rituximab无关 (p=0.005).
患有ASL的患者初始复发风险较高 (HR=4.658,p=0.007),但在调整其他因素后 (HR=2.297,p=0.195) 这并不显著.

结论:

在AQP4-NMOSD中可能发生ASL,这可能表明免疫疗法不足.
免疫抑制疗法,特别是rituximab和mycophenolate mofetil,显著降低了复发风险.
单独存在ASL可能不是对AQP4-NMOSD未来复发的重要独立预测因素.

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