Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Neurol Sci. 2010 Apr 15;291(1-2):37-43. doi: 10.1016/j.jns.2010.01.009. Epub 2010 Feb 1.
Brain lesions are not uncommon in neuromyelitis optica (NMO) patients with anti-aquaporin-4 (AQP4) antibody; however, the appearance of these lesions is said to be different from that of those in Western patients with multiple sclerosis (MS). To clarify the similarities and dissimilarities of brain lesions in anti-AQP4 antibody-positive and -negative MS and NMO patients, we examined the presence of anti-AQP4 antibody in the sera of 148 consecutive patients fulfilling Poser's criteria for clinically definite MS, of whom 38 also met the revised NMO criteria, using an immunofluorescence method, and analyzed brain lesions by magnetic resonance imaging (MRI). Brain lesions fulfilling the Barkhof criteria were significantly more common in 121 patients without anti-AQP4 antibody than in 27 patients with anti-AQP4 antibody (57.0% vs. 33.3%, P=0.033), while the frequency of those that met the Paty criteria was not different between the two groups (74.4% vs. 73.5%). Ovoid lesions were detected more commonly in patients without anti-AQP4 antibody than in those with the antibody (72.3% vs. 48.2%, P=0.022). The anti-AQP4 antibody-positive patients had significantly more atypical brain lesions, such as extensive brain lesions, than the anti-AQP4 antibody-negative ones (18.5% vs. 1.7%, P=0.0023). Thus, although MS-like brain lesions are more common in anti-AQP4 antibody-negative patients than anti-AQP4 antibody-positive patients, approximately 30 to 50% of patients with anti-AQP4 antibody harbour brain MRI lesions indistinguishable from those present in typical MS patients, such as periventricular ovoid lesions, suggesting the existence of considerable overlap in brain MRI features between anti-AQP4 antibody-positive and -negative Asian patients. In the present study, NMO patients with brain lesions showed a significantly higher annualized relapse rate (P(corr)=0.017) and higher frequency of anti-AQP4 antibody (P(corr)<0.0001) than typical NMO patients without brain lesions, suggesting that development of brain lesions in NMO may reflect high disease activity and thus be a warning sign.
脑损伤在抗水通道蛋白 4（AQP4）抗体阳性的视神经脊髓炎（NMO）患者中并不少见；然而，这些病变的表现据称与西方多发性硬化（MS）患者的不同。为了阐明抗 AQP4 抗体阳性和阴性 MS 和 NMO 患者脑损伤的相似性和差异性，我们使用免疫荧光法检测了 148 例符合 Poser 临床确诊 MS 标准的连续患者血清中的抗 AQP4 抗体，其中 38 例也符合修订后的 NMO 标准，并通过磁共振成像（MRI）分析了脑损伤。在 121 例无抗 AQP4 抗体的患者中，符合 Barkhof 标准的脑损伤明显比 27 例有抗 AQP4 抗体的患者更常见（57.0%比 33.3%，P=0.033），而两组之间符合 Paty 标准的脑损伤频率无差异（74.4%比 73.5%）。无抗 AQP4 抗体的患者比有抗 AQP4 抗体的患者更常见卵圆形病变（72.3%比 48.2%，P=0.022）。抗 AQP4 抗体阳性的患者比阴性的患者有更多的非典型脑损伤，如广泛的脑损伤（18.5%比 1.7%，P=0.0023）。因此，尽管抗 AQP4 抗体阴性患者比阳性患者更常见 MS 样脑损伤，但约 30%至 50%的抗 AQP4 抗体阳性患者存在脑 MRI 病变，与典型 MS 患者的病变难以区分，如脑室周围卵圆形病变，这表明亚洲抗 AQP4 抗体阳性和阴性患者的脑 MRI 特征存在相当大的重叠。在本研究中，有脑损伤的 NMO 患者的年复发率（校正 P=0.017）和抗 AQP4 抗体的频率（校正 P<0.0001）明显高于无脑损伤的典型 NMO 患者，这表明 NMO 患者脑损伤的发生可能反映了疾病的高度活动，因此是一个警告信号。
