Takahashi T, Miyazawa I, Misu T, Takano R, Nakashima I, Fujihara K, Tobita M, Itoyama Y
Department of Neurology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai 980-8574, Japan.
J Neurol Neurosurg Psychiatry. 2008 Sep;79(9):1075-8. doi: 10.1136/jnnp.2008.145391. Epub 2008 Apr 17.
Intractable hiccup and nausea (IHN) are unique symptoms in neuromyelitis optica (NMO). Recent studies have strongly suggested that the pathogenesis of NMO is closely associated with anti-aquaporin-4 (AQP4) antibody. However, clinical implications of IHN and the relationship with anti-AQP4 antibody remain unknown.
The past medical records of 35 patients with seropositivity for anti-AQP4 antibody were reviewed. We also followed the titres of anti-AQP4 antibody in a patient with NMO, who had newly developed IHN.
Of the 35 patients, 15 patients (43%) had episodes of IHN. There was a total of 35 episodes of IHN in these 15 patients and, of the 35 episodes, hiccup was seen in 23 episodes (66%) and nausea was seen in 28 episodes (80%). The IHN frequently preceded (54%) or accompanied (29%) myelitis or optic neuritis. The IHN was often preceded by an episode of viral infection. The titres of anti-AQP4 antibody were remarkably increased when the intractable hiccup appeared in a case.
IHN could be a clinical marker for the early phase of an exacerbation. Careful observation may be needed when INH is seen in patients with NMO, and the early initiation of the treatment could prevent subsequent neurological damage.
顽固性呃逆和恶心（IHN）是视神经脊髓炎（NMO）的独特症状。近期研究强烈提示，NMO的发病机制与抗水通道蛋白4（AQP4）抗体密切相关。然而，IHN的临床意义及其与抗AQP4抗体的关系仍不明确。
回顾了35例抗AQP4抗体血清学阳性患者的既往病历。我们还对1例新出现IHN的NMO患者的抗AQP4抗体滴度进行了随访。
35例患者中，15例（43%）有IHN发作。这15例患者共有35次IHN发作，在这35次发作中，呃逆出现23次（66%），恶心出现28次（80%）。IHN常先于（54%）或伴随（29%）脊髓炎或视神经炎出现。IHN常先于病毒感染发作。在1例患者中，当出现顽固性呃逆时，抗AQP4抗体滴度显著升高。
IHN可能是病情加重早期的临床标志物。NMO患者出现INH时可能需要仔细观察，早期开始治疗可预防随后的神经损伤。
Zotero 插件