视神经脊髓炎谱系疾病患者视神经损害相关因素分析
发布时间：2019-01-09 01:41
【摘要】：研究目的:分析NMOSD患者视神经损害的临床、血液、脑脊液特点,探讨与NMOSD视神经损害发生相关的危险因素及其临床意义。研究方法:回顾性分析2010年1月-2016年2月在长海医院神经内科以2015年版国际共识及诊断标准纳入的108例NMOSD患者,收集患者临床与生化资料,根据是否有视神经损害分为视神经损害组与无视神经损害组,并比较两组患者间的临床与生化特征;根据AQP4抗体是否阳性将患者分为AQP4抗体阳性组与阴性组,并比较两组间的临床、生化特点,通过Speaman及Pearson相关分析探究AQP4抗体、血肌酐与NMOSD患者视神经损害的相关性,以此探讨NMOSD视神经损害的发病机制;根据男女性别分组分析血肌酐与视神经损害发生的相关性,通过多因素分析血肌酐水平对视神经损害的风险性。研究结果:本研究纳入的108例NMOSD患者中,视神经损害组53例,无视神经损害55例,两组之间性别、发病年龄、病程、外周血白细胞、谷丙转氨酶、脑脊液蛋白、脑脊液免疫球蛋白及寡克隆带比较无统计学差异(P0.05),复发次数、血肌酐及AQP4抗体比较有统计学差异(P0.05)。AQP4抗体阳性组50例,阴性组17例,两组之间视神经损害发生率比较有统计学差异(X2=8.267,P0.05)。AQP4抗体与视神经损害发生呈正相关(r=0.351,P0.05)。视神经损害组患者血肌酐中位数54.00μmol/L,四分位间距15.00μmol/L;无视神经损害组血肌酐中位数61.00μmol/L,四分位间距24.00μmol/L,两组间血肌酐比较有统计学差异(P=0.018),血肌酐水平与视神经损害发生呈负相关(r=-0.260,P0.05)。在NMOSD总体人群中视神经损害与无损害组血肌酐水平有显著统计学差异,通过分层分析,这种差异性在男性患者中仍然存在(P=0.024)。将男性患者按血肌酐测值分成渐升高的三等份,三组间视神经损害发生率比较有统计学差异(P=0.048)。考虑到年龄、复发次数、AQP4抗体等因素影响,在男性患者中,分析逐渐升高的三组血肌酐水平对视神经损害的风险比,Q1为基线水平,此时OR=1.0,随着SCR值增加,SCR对视神经损害发生的OR为0.33、0.05,其保护作用随之增加。研究结论:本研究结果显示AQP4抗体阳性的NMOSD患者易出现视神经损害,是其危险因素,两者正相关性有助于NMOSD患者视神经损害的早期预判及病情监测。本研究证实较高的血肌酐水平可能降低视神经损害的发生率,两者负相关性提示血肌酐可能为NMOSD患者视神经损害的保护性因素,尤其对男性患者而言,但肯定结论尚需大样本前瞻性研究进一步证实。
[Abstract]:Objective: to analyze the clinical, blood and cerebrospinal fluid (CSF) features of optic nerve damage in patients with NMOSD, and to explore the risk factors associated with optic nerve damage in NMOSD and its clinical significance. Methods: the clinical and biochemical data of 108 patients with NMOSD were analyzed retrospectively from January 2010 to February 2016 in the Department of Neurology, Changhai Hospital, according to the international consensus and diagnostic criteria of 2015 edition, and the clinical and biochemical data of the patients were collected. According to whether there was optic nerve damage, the patients were divided into optic nerve injury group and non-optic nerve injury group, and the clinical and biochemical characteristics between the two groups were compared. According to whether the AQP4 antibody is positive or not, the patients were divided into AQP4 antibody positive group and negative group. The clinical and biochemical characteristics of the two groups were compared. The correlation between AQP4 antibody, serum creatinine and optic nerve damage in NMOSD patients was investigated by Speaman and Pearson correlation analysis. To explore the pathogenesis of optic nerve injury in NMOSD. The correlation between serum creatinine and optic nerve injury was analyzed according to the sex groups of men and women. The risk of optic nerve damage was analyzed by multivariate analysis of serum creatinine level. Results: in this study, there were 53 cases of optic nerve injury group and 55 cases of no optic nerve damage. Sex, age, course of disease, peripheral white blood cell, glutamic pyruvate aminotransferase, cerebrospinal fluid protein were all involved in this study. There was no significant difference in CSF immunoglobulin and oligoclonal bands (P0.05), but the recurrence times, serum creatinine and AQP4 antibody were significantly different (P0.05). There were 50 cases of positive AQP4 antibody group, 17 cases of negative group, 50 cases of AQP4 antibody positive group, 17 cases of negative group. The incidence of optic nerve damage was significantly different between the two groups (X2 + 8.267). There was a positive correlation between AQP4 antibody and optic nerve damage (r = 0.351 P 0.05). Median serum creatinine 54.00 渭 mol/L, quartile spacing 15.00 渭 mol/L; in optic nerve lesion group There was a significant difference in serum creatinine between the two groups (P0. 018). There was a negative correlation between serum creatinine level and optic nerve damage (r = 0. 260, P < 0. 260). P0.05). There were significant differences in creatinine levels between the optic nerve injury group and the non-damaged group in the NMOSD population, and the difference was still found in male patients by stratified analysis (P0. 024). The male patients were divided into three equal groups according to the serum creatinine test value. The incidence of optic nerve damage was significantly different among the three groups (P0. 048). Considering the influence of age, relapse times and AQP4 antibody, the risk ratio of serum creatinine level to optic nerve damage was analyzed in male patients. Q1 was the baseline level, and OR=1.0, increased with the increase of SCR value. The OR of SCR on optic nerve injury was 0.33 0. 05, and its protective effect was increased. Conclusion: the results of this study show that NMOSD patients with positive AQP4 antibody are prone to optic nerve damage, which is a risk factor. The positive correlation between the two factors is helpful to early prediction and disease monitoring of optic nerve damage in NMOSD patients. This study confirmed that high serum creatinine levels may reduce the incidence of optic nerve damage. The negative correlation between the two suggests that serum creatinine may be a protective factor for optic nerve damage in NMOSD patients, especially in men. But the positive conclusion needs to be further confirmed by a large sample of prospective studies.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.52
本文编号：2405155
[Abstract]:Objective: to analyze the clinical, blood and cerebrospinal fluid (CSF) features of optic nerve damage in patients with NMOSD, and to explore the risk factors associated with optic nerve damage in NMOSD and its clinical significance. Methods: the clinical and biochemical data of 108 patients with NMOSD were analyzed retrospectively from January 2010 to February 2016 in the Department of Neurology, Changhai Hospital, according to the international consensus and diagnostic criteria of 2015 edition, and the clinical and biochemical data of the patients were collected. According to whether there was optic nerve damage, the patients were divided into optic nerve injury group and non-optic nerve injury group, and the clinical and biochemical characteristics between the two groups were compared. According to whether the AQP4 antibody is positive or not, the patients were divided into AQP4 antibody positive group and negative group. The clinical and biochemical characteristics of the two groups were compared. The correlation between AQP4 antibody, serum creatinine and optic nerve damage in NMOSD patients was investigated by Speaman and Pearson correlation analysis. To explore the pathogenesis of optic nerve injury in NMOSD. The correlation between serum creatinine and optic nerve injury was analyzed according to the sex groups of men and women. The risk of optic nerve damage was analyzed by multivariate analysis of serum creatinine level. Results: in this study, there were 53 cases of optic nerve injury group and 55 cases of no optic nerve damage. Sex, age, course of disease, peripheral white blood cell, glutamic pyruvate aminotransferase, cerebrospinal fluid protein were all involved in this study. There was no significant difference in CSF immunoglobulin and oligoclonal bands (P0.05), but the recurrence times, serum creatinine and AQP4 antibody were significantly different (P0.05). There were 50 cases of positive AQP4 antibody group, 17 cases of negative group, 50 cases of AQP4 antibody positive group, 17 cases of negative group. The incidence of optic nerve damage was significantly different between the two groups (X2 + 8.267). There was a positive correlation between AQP4 antibody and optic nerve damage (r = 0.351 P 0.05). Median serum creatinine 54.00 渭 mol/L, quartile spacing 15.00 渭 mol/L; in optic nerve lesion group There was a significant difference in serum creatinine between the two groups (P0. 018). There was a negative correlation between serum creatinine level and optic nerve damage (r = 0. 260, P < 0. 260). P0.05). There were significant differences in creatinine levels between the optic nerve injury group and the non-damaged group in the NMOSD population, and the difference was still found in male patients by stratified analysis (P0. 024). The male patients were divided into three equal groups according to the serum creatinine test value. The incidence of optic nerve damage was significantly different among the three groups (P0. 048). Considering the influence of age, relapse times and AQP4 antibody, the risk ratio of serum creatinine level to optic nerve damage was analyzed in male patients. Q1 was the baseline level, and OR=1.0, increased with the increase of SCR value. The OR of SCR on optic nerve injury was 0.33 0. 05, and its protective effect was increased. Conclusion: the results of this study show that NMOSD patients with positive AQP4 antibody are prone to optic nerve damage, which is a risk factor. The positive correlation between the two factors is helpful to early prediction and disease monitoring of optic nerve damage in NMOSD patients. This study confirmed that high serum creatinine levels may reduce the incidence of optic nerve damage. The negative correlation between the two suggests that serum creatinine may be a protective factor for optic nerve damage in NMOSD patients, especially in men. But the positive conclusion needs to be further confirmed by a large sample of prospective studies.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.52
【参考文献】
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2 陈志志;张淑坤;吴世政;;水通道蛋白4与神经系统疾病[J];中国神经精神疾病杂志;2014年10期
3 张晓君;许贤豪;;视神经脊髓炎谱系疾病神经眼科表现[J];中国现代神经疾病杂志;2014年10期
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