伴系统性自身免疫病的视神经脊髓炎谱系疾病的临床和影像特点
发布时间：2019-01-29 20:35
【摘要】：目的探讨视神经脊髓炎谱系疾病(NMOSD)合并系统性自身免疫性疾病(SADs)的临床、影像特点。方法分析2012年～2016年于浙江大学医学院附属第二医院神经内科住院的符合2015年NMOSD诊断标准的81例患者的临床、影像等资料,并将81例患者按照是否伴有系统性自身免疫性疾病(SADs)分为两组,对比两组患者之间的临床、影像等特点。结果81例NMOSD患者中,伴有SADs患者19例(23.5%),不伴SADs患者62例(76.5%).81例患者全部送检抗AQP4抗体,其中77例(95.1%)抗AQP4抗体阳性。血清中抗AQP4抗体阳性率高于脑脊液(p0.05),血清中抗体滴度同样比脑脊液中更高(p0.05)。15例送检MOG抗体,其中2例(13.3%)阳性。伴SADs亚组患者血清甲状腺球蛋白抗体、抗核抗体等自身免疫抗体阳性率显著高于不伴SADs亚组。伴SADs亚组的14例存在脊髓病变的患者中未发现延髓颈髓病变相连者(0%),低于不伴SADs亚组(24.5%),差异具有统计学意义(p=0.039)。伴SADs亚组患者脊髓磁共振矢状位上病变受累长度(以对应椎体节数计)为5.64±2.73,不伴SADs亚组患者受累长度为4.13±2.21,差异具有统计学意义(p=0.040)。两组患者在发病年龄、性别比、临床表现方面未见明显差别(p0.05)。两组患者在头颅磁共振病灶分布、病灶强化情况,脊髓磁共振受累部位、横贯性脊髓炎比例、长节段脊髓炎比例、病灶强化情况等方面同样未见显著性差别(p0.05)。结论伴SADs的NMOSD患者与不伴SADs的NMOSD患者在发病年龄、性别比、临床表现、头颅磁共振表现方面无明显差别,伴SADs的NMOSD患者脊髓病变节段较长,较少出现颈髓延髓相连病灶。当NMOSD患者伴有自身免疫抗体阳性、磁共振脊髓病变节段较长时,需要警惕NMOSD伴有SADs的可能性。
[Abstract]:Objective to investigate the clinical and imaging features of (NMOSD) with systemic autoimmune disease (SADs). Methods the clinical and imaging data of 81 patients admitted to the Department of Neurology of the second affiliated Hospital of Zhejiang University Medical College from 2012 to 2016 who were in accordance with the 2015 NMOSD diagnostic criteria were analyzed. 81 patients were divided into two groups according to whether or not with systemic autoimmune disease (SADs). The clinical and imaging features of the two groups were compared. Results among 81 cases of NMOSD, 19 cases (23.5%) were accompanied with SADs, 62 cases (76.5%) were without SADs. All 81 cases were tested for anti-AQP4 antibody, of which 77 cases (95.1%) were positive for anti-AQP4 antibody. The positive rate of anti AQP4 antibody in serum was higher than that in cerebrospinal fluid (p 0. 05), and the titer of anti AQP4 antibody in serum was also higher than that in cerebrospinal fluid (p 0. 05). Among them, 2 cases (13. 3%) were positive for MOG antibody. The positive rates of serum thyroglobulin antibodies and antinuclear antibodies in patients with SADs subgroup were significantly higher than those in patients without SADs subgroup. In 14 patients with spinal cord disease with SADs subgroup, there was no contiguous medullary cervical spinal cord lesion (0%), which was significantly lower than that without SADs subgroup (24. 5%) (p0. 039). The length of involvement in sagittal position of spinal cord in patients with SADs subgroup was 5.64 卤2.73 (corresponding to the number of vertebral body segments), and that in patients without SADs subgroup was 4.13 卤2.21, the difference was statistically significant (p0. 040). There was no significant difference in age, sex ratio and clinical manifestation between the two groups (p 0.05). There was also no significant difference between the two groups in the distribution of cranial MRI lesions, enhancement of lesions, the location of MRI involvement, the proportion of transverse myelitis, the proportion of long segment myelitis, and the enhancement of lesions (p0.05). Conclusion there is no significant difference in age, sex ratio, clinical manifestation and cranial magnetic resonance imaging between NMOSD patients with SADs and NMOSD patients without SADs. NMOSD patients with SADs have longer segments of spinal cord lesions and fewer cervical medulla oblongata lesions. When NMOSD patients are associated with autoimmune antibodies and long segments of MRI spinal cord lesions, the possibility of NMOSD with SADs should be warned.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.52;R593.2
，
本文编号：2417840
[Abstract]:Objective to investigate the clinical and imaging features of (NMOSD) with systemic autoimmune disease (SADs). Methods the clinical and imaging data of 81 patients admitted to the Department of Neurology of the second affiliated Hospital of Zhejiang University Medical College from 2012 to 2016 who were in accordance with the 2015 NMOSD diagnostic criteria were analyzed. 81 patients were divided into two groups according to whether or not with systemic autoimmune disease (SADs). The clinical and imaging features of the two groups were compared. Results among 81 cases of NMOSD, 19 cases (23.5%) were accompanied with SADs, 62 cases (76.5%) were without SADs. All 81 cases were tested for anti-AQP4 antibody, of which 77 cases (95.1%) were positive for anti-AQP4 antibody. The positive rate of anti AQP4 antibody in serum was higher than that in cerebrospinal fluid (p 0. 05), and the titer of anti AQP4 antibody in serum was also higher than that in cerebrospinal fluid (p 0. 05). Among them, 2 cases (13. 3%) were positive for MOG antibody. The positive rates of serum thyroglobulin antibodies and antinuclear antibodies in patients with SADs subgroup were significantly higher than those in patients without SADs subgroup. In 14 patients with spinal cord disease with SADs subgroup, there was no contiguous medullary cervical spinal cord lesion (0%), which was significantly lower than that without SADs subgroup (24. 5%) (p0. 039). The length of involvement in sagittal position of spinal cord in patients with SADs subgroup was 5.64 卤2.73 (corresponding to the number of vertebral body segments), and that in patients without SADs subgroup was 4.13 卤2.21, the difference was statistically significant (p0. 040). There was no significant difference in age, sex ratio and clinical manifestation between the two groups (p 0.05). There was also no significant difference between the two groups in the distribution of cranial MRI lesions, enhancement of lesions, the location of MRI involvement, the proportion of transverse myelitis, the proportion of long segment myelitis, and the enhancement of lesions (p0.05). Conclusion there is no significant difference in age, sex ratio, clinical manifestation and cranial magnetic resonance imaging between NMOSD patients with SADs and NMOSD patients without SADs. NMOSD patients with SADs have longer segments of spinal cord lesions and fewer cervical medulla oblongata lesions. When NMOSD patients are associated with autoimmune antibodies and long segments of MRI spinal cord lesions, the possibility of NMOSD with SADs should be warned.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.52;R593.2
，
本文编号：2417840
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