Matiello M, Lennon V A, Jacob A, Pittock S J, Lucchinetti C F, Wingerchuk D M, Weinshenker B G
Department of Neurology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
Neurology. 2008 Jun 3;70(23):2197-200. doi: 10.1212/01.wnl.0000303817.82134.da. Epub 2008 Apr 23.
To determine the prognostic value of neuromyelitis optica (NMO)-immunoglobulin G (IgG) in patients with recurrent optic neuritis (ON). The aquaporin-4-specific serum autoantibody, NMO-IgG, is a biomarker for NMO and relapsing transverse myelitis. Recurrent ON may herald multiple sclerosis (MS) or NMO, or it may occur as an isolated syndrome. The prognosis and response to therapy differs in each of these contexts.
We evaluated 34 patients who were tested for NMO-IgG between 2000 and 2007 and who had two or more episodes of ON without satisfying a diagnosis of MS or NMO prior to serologic testing. Clinical data were available for 25 Mayo Clinic patients (5 NMO-IgG positive and 20 NMO-IgG negative) and for an additional 9 seropositive patients whose serum was referred to the Mayo Clinic Neuroimmunology laboratory for testing.
Twenty percent of the patients with recurrent ON seen at Mayo Clinic were seropositive. All NMO-IgG-positive patients (vs 65% NMO-IgG-negative patients) had at least one attack with visual acuity in the affected eye worse than 20/200 (p = 0.05). In seropositive patients for whom long-term follow-up was possible (median 8.9 years after the initial ON), 6 of 12 (50%) experienced an episode of myelitis and fulfilled criteria for NMO. In contrast, 1 of 15 seronegative patients (6.7%) fulfilled McDonald criteria for MS (p = 0.03). Seropositive patients had a final visual score which was worse than that of seronegative patients (p = 0.02).
Neuromyelitis optica (NMO)-immunoglobulin G seropositivity predicts poor visual outcome and development of NMO. Seropositive recurrent optic neuritis is a limited form of NMO.
确定视神经脊髓炎（NMO）-免疫球蛋白G（IgG）在复发性视神经炎（ON）患者中的预后价值。水通道蛋白4特异性血清自身抗体NMO-IgG是NMO和复发性横贯性脊髓炎的生物标志物。复发性ON可能预示着多发性硬化（MS）或NMO，也可能作为一种孤立综合征出现。在上述每种情况下，预后和对治疗的反应都有所不同。
我们评估了2000年至2007年间接受NMO-IgG检测的34例患者，这些患者有两次或更多次ON发作，且在血清学检测前未满足MS或NMO的诊断标准。梅奥诊所的25例患者（5例NMO-IgG阳性和20例NMO-IgG阴性）以及另外9例血清阳性患者（其血清被送至梅奥诊所神经免疫学实验室进行检测）有临床数据。
在梅奥诊所就诊的复发性ON患者中，20%血清阳性。所有NMO-IgG阳性患者（相比65%的NMO-IgG阴性患者）至少有一次发作时患眼视力低于20/200（p = 0.05）。在血清阳性且可能进行长期随访的患者中（首次ON发作后中位时间8.9年），12例中有6例（50%）经历了脊髓炎发作并符合NMO标准。相比之下，15例血清阴性患者中有1例（6.7%）符合MS的麦克唐纳标准（p = 0.03）。血清阳性患者的最终视力评分低于血清阴性患者（p = 0.02）。
视神经脊髓炎（NMO）-免疫球蛋白G血清阳性预示视力预后不良和NMO的发生。血清阳性复发性视神经炎是NMO的一种局限形式。
