Apiwattanakul Metha, Kasemsuk Chayut
Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand.
Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand.
Mult Scler Relat Disord. 2014 Jan;3(1):61-6. doi: 10.1016/j.msard.2013.06.009. Epub 2013 Jul 18.
Neuromyelitis optica (NMO) is more prevalent than multiple sclerosis (MS) in the Asian population. AQP4-IgG as a specific biomarker for NMO has not been systematically validated in Thai patients.
To identify the proportion of central nervous system demyelinating disease of Thai patient in one of referral center and examine its clinico-serological correlation with AQP4-IgG status.
Cross sectional collected sera from patients who visited or were admitted to Prasat Neurological Institute from November 2009 to August 2010 were tested for serum AQP4-IgG levels. Patient information was reviewed and diagnoses of MS and clinical isolated syndrome (CIS) were made using the Revised McDonald criteria 2005. Diagnosis of NMO was made using the Revised NMO criteria 2006 (except for AQP4-IgG status) and NMO spectrum disorder (NMOSD) criteria 2007.
Sixty-one patients were identified including 12 with NMO, 25 with limited form of NMO, 16 with relapsing remitting MS (RRMS), and 8 with CIS. AQP4-IgG was found in 65% of patients in the NMOSD group. In the MS/CIS group, 2 were AQP4-IgG seropositive. Pleocytosis was significantly higher in the NMOSD group than the MS/CIS group. Cranial MRI revealed that the size and degree of brain lesions were similar in all study groups. However, spinal MRI showed that the MS/CIS groups had a higher prevalence of short segment myelitis and a higher abundance of white matter (p<0.05) than NMOSD group. AQP4-IgG seropositive samples correlated with female patients and the presence of optic neuritis.
NMOSD is more common than MS in Thai patients. Moreover, AQP4-IgG is highly specific for NMOSD. Spinal MRI can effectively distinguish NMOSD from MS patients. AQP4-IgG seropositivity is highly correlated with females and the presence of optic neuritis.
视神经脊髓炎（NMO）在亚洲人群中比多发性硬化症（MS）更为普遍。水通道蛋白4-IgG（AQP4-IgG）作为NMO的一种特异性生物标志物，尚未在泰国患者中得到系统验证。
确定一家转诊中心泰国患者中枢神经系统脱髓鞘疾病的比例，并研究其与AQP4-IgG状态的临床血清学相关性。
对2009年11月至2010年8月期间到帕萨特神经研究所就诊或住院的患者进行横断面血清采集，检测血清AQP4-IgG水平。回顾患者信息，并根据2005年修订的麦克唐纳标准对MS和临床孤立综合征（CIS）进行诊断。根据2006年修订的NMO标准（AQP4-IgG状态除外）和2007年NMO谱系障碍（NMOSD）标准对NMO进行诊断。
共确定61例患者，其中12例为NMO，25例为局限性NMO，16例为复发缓解型MS（RRMS），8例为CIS。NMOSD组65%的患者检测到AQP4-IgG。在MS/CIS组中，2例AQP4-IgG血清学阳性。NMOSD组的脑脊液细胞数显著高于MS/CIS组。头颅MRI显示，所有研究组脑病变的大小和程度相似。然而，脊髓MRI显示，MS/CIS组短节段脊髓炎的患病率和白质丰度均高于NMOSD组（p<0.05）。AQP4-IgG血清学阳性样本与女性患者及视神经炎的存在相关。
在泰国患者中，NMOSD比MS更常见。此外，AQP4-IgG对NMOSD具有高度特异性。脊髓MRI可以有效地区分NMOSD患者和MS患者。AQP4-IgG血清学阳性与女性及视神经炎的存在高度相关。
