Deschamps R, Lecler A, Lamirel C, Aboab J, Gueguen A, Bensa C, Vignal C, Gout O
Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, Paris.
Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris.
Eur J Neurol. 2017 Jun;24(6):875-879. doi: 10.1111/ene.13315. Epub 2017 May 6.
New criteria for the diagnosis of multiple sclerosis (MS) and discovery of myelin oligodendrocyte glycoprotein (MOG) or aquaporin-4 (AQP4) antibodies (Abs) have changed the management of optic neuritis (ON). Our aim was to specify, in view of these recent advances, the etiologies of acute demyelinating ON for consecutive patients.
Retrospective database analysis was undertaken of consecutive adult patients with acute ON admitted from 1 December 2014 to 31 January 2016. Diagnosis of MS was made according to the 2010 McDonald criteria. Patients with Abs to AQP4 or MOG were classified as ON-AQP4 and ON-MOG, respectively. Patients who did not fulfill the diagnostic criteria and were negative for AQP4 and MOG Ab tests were classified as having idiopathic ON.
Of 110 patients assessed, 78 had ON related to MS (70.9%). All patients without MS were tested for AQP4 and MOG Abs: 11 had MOG Ab (10%), 5 had AQP4 Ab (4.5%) and 16 were considered as having idiopathic ON (14.5%). Presence of intrathecal IgG oligoclonal bands was strongly associated with MS (mean, 88.4% vs. 34.4% in patients without MS; after Bonferroni correction, P < 0.0001).
Optic neuritis related to MOG Ab was the second cause identified of demyelinating ON in our center. Idiopathic ON was as frequent as both ON-AQP4 and ON-MOG combined.
多发性硬化症（MS）诊断的新标准以及髓鞘少突胶质细胞糖蛋白（MOG）或水通道蛋白4（AQP4）抗体（Abs）的发现改变了视神经炎（ON）的治疗方法。鉴于这些最新进展，我们的目的是明确连续患者急性脱髓鞘性视神经炎的病因。
对2014年12月1日至2016年1月31日收治的连续成年急性视神经炎患者进行回顾性数据库分析。根据2010年麦克唐纳标准诊断多发性硬化症。抗AQP4或MOG的患者分别归类为视神经炎-AQP4和视神经炎-MOG。未符合诊断标准且AQP4和MOG抗体检测为阴性的患者归类为特发性视神经炎。
在评估的110例患者中，78例患有与多发性硬化症相关的视神经炎（70.9%）。所有无多发性硬化症的患者均检测了AQP4和MOG抗体：11例有MOG抗体（10%），5例有AQP4抗体（4.5%），16例被认为患有特发性视神经炎（14.5%）。鞘内IgG寡克隆带的存在与多发性硬化症密切相关（平均值，88.4%对无多发性硬化症患者的34.4%；经Bonferroni校正后，P<0.0001）。
与MOG抗体相关的视神经炎是我们中心确定的脱髓鞘性视神经炎的第二大病因。特发性视神经炎的发生率与视神经炎-AQP4和视神经炎-MOG的总和一样高。
