Harirchian Mohammad Hossein, Tafakhori Abbas, Taslimi Shervin, Aghamollaii Vajiheh, Shahsiah Reza, Gholipour Taha, Mohammadi Fatemezahra, Zare-Shahabadi Ameneh
Iranian Center of Neurological Research, Tehran University of Medical Sciences.
Partners MS Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Iran J Allergy Asthma Immunol. 2015 Feb;14(1):98-104.
Neuromyelitis optica is an inflammatory demyelinating disease (IDD) of the CNS, which mainly affects optic nerve and spinal cord. Autoantibodies against aquaporin-4 also known as NMO-IgG have been implicated in the pathogenesis of NMO. We evaluated the sensitivity and specificity of NMO-IgG assay for diagnosing NMO patients and differentiating them from MS patients and those with undifferentiated IDD with overlap symptoms.Eligibility of patients with demyelinating disorders was evaluated based on physical examination, laboratory and imaging studies. Thirty four definite NMO patients (disregarding NMO-IgG status), 34 multiple sclerosis (MS) patients with a history of optic neuritis (ON) or myelitis that were matched for age and disease activity and 44 patients with ON or myelitis attacks fulfilling neither criteria of MS or NMO (NMO spectrum) were selected as undifferentiated group. NMO-IgG was measured in the serum of the included patients by cell-based indirect immunofluorescence assay (IFA). NMO antibody was positive in 11 (32.3%), and 4 (9.09%) patients in NMO and undifferentiated groups, but was undetctable in MS patients. NMO antibody was 32% (95%Cl: 19-49%) sensitive in detecting NMO patients. Its specificity in differentiating NMO from MS subjects was 100 % (95% Cl: 90-!00%). NMO antibody was 95% (95% Cl: 0.88-0.98) specific in differentiating NMOs from other demyelinating diseases. Our results showed that although NMO antibody is highly specific for NMO, current method of measuring it with cell-based IFA is not highly sensitive for diagnosing NMO patients.
视神经脊髓炎是一种中枢神经系统的炎性脱髓鞘疾病（IDD），主要累及视神经和脊髓。针对水通道蛋白4的自身抗体（也称为NMO-IgG）与视神经脊髓炎的发病机制有关。我们评估了NMO-IgG检测在诊断视神经脊髓炎患者以及将其与多发性硬化症患者和有重叠症状的未分化炎性脱髓鞘疾病患者进行鉴别诊断时的敏感性和特异性。基于体格检查、实验室检查和影像学研究评估脱髓鞘疾病患者的入选资格。选取34例确诊的视神经脊髓炎患者（不考虑NMO-IgG状态）、34例有视神经炎（ON）或脊髓炎病史且年龄和疾病活动度相匹配的多发性硬化症（MS）患者以及44例ON或脊髓炎发作但不符合MS或视神经脊髓炎标准（NMO谱系）的患者作为未分化组。通过基于细胞的间接免疫荧光法（IFA）检测纳入患者血清中的NMO-IgG。NMO组和未分化组中分别有11例（32.3%）和4例（9.09%）患者的NMO抗体呈阳性，但MS患者中未检测到。NMO抗体检测视神经脊髓炎患者的敏感性为32%（95%CI：19-49%）。其在鉴别视神经脊髓炎与MS患者时的特异性为100%（95%CI：90-100%）。NMO抗体在鉴别视神经脊髓炎与其他脱髓鞘疾病时的特异性为95%（95%CI：0.88-0.98）。我们的结果表明，尽管NMO抗体对视神经脊髓炎具有高度特异性，但目前基于细胞的IFA检测方法在诊断视神经脊髓炎患者时敏感性不高。
