验证 2015 年视神经脊髓炎谱系疾病诊断标准在南印度患者队列中的适用性。
Validation of the 2015 diagnostic criteria for neuromyelitis optica spectrum disorders in a cohort of South Indian patients.
机构信息
Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082, India.
Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082, India.
出版信息
Mult Scler Relat Disord. 2019 Oct;35:164-169. doi: 10.1016/j.msard.2019.07.024. Epub 2019 Jul 29.
BACKGROUND
Neuromyelitis Optica spectrum disorders (NMOSD) are one of the most common CNS demyelinating disorders as they will present with disabling recurrent demyelinating attacks. Hence, it is of paramount importance to diagnose early, and early diagnoses and intervention will prevent further relapses associated with NMOSD. New international consensus criteria have been proposed and studies validating its application towards diagnoses of NMOSD in south Asian population are meagre. Hence we validated the proposed International Panel for NMO Diagnosis (IPND), 2015 criteria to study the clinical, demographic profile and sero-status of patients who are presenting with core clinical symptoms of NMOSD in South India and compare it with 2006 criteria.
METHODS
A retrospective study was conducted in a tertiary hospital for a period of one year. Patients who had at least one core clinical feature of NMOSD were included. Demographics and clinical data were recorded and analysed. Cases were evaluated using 2015 IPND and 2006 criteria for all patients, data was analysed using SPSS.
RESULTS
A total of 110 patients were included and 91(82.72%) patients fulfilled IPND 2015 criteria. Out of 91 patients, 70 patients were AQP4 antibody positive and 21 were negative. Out of 110, only 30 (27.2%) satisfied 2006 criteria (24 or 80% were seropositive). 2015 criteria were more sensitive in identifying 61 new NMOSD cases juxtaposed to 2006 criteria, this difference was statistically significant (P<0.05).
CONCLUSION
The 2015 IPND criteria were more sensitive and specific than previous 2006 criteria as it covered diverse clinical manifestations of NMOSD. Applying this criteria, NMOSD could be diagnosed among patients with monophasic illness, isolated recurrent optic neuritis, isolated recurrent myelitis, cerebral syndrome, diencephalic syndrome, brainstem syndrome and area postrema syndrome, thus improving the diagnostic yield.
背景
视神经脊髓炎谱系疾病（NMOSD）是最常见的中枢神经系统脱髓鞘疾病之一，因为它们会出现致残性复发性脱髓鞘发作。因此，早期诊断至关重要，早期诊断和干预将防止与 NMOSD 相关的进一步复发。已经提出了新的国际共识标准，并且针对南亚人群 NMOSD 诊断验证这些标准的研究很少。因此，我们验证了拟议的国际 NMOSD 诊断小组（IPND），2015 年标准，以研究在印度南部出现 NMOSD 核心临床症状的患者的临床、人口统计学特征和血清状态，并将其与 2006 年标准进行比较。
方法
在一家三级医院进行了一项为期一年的回顾性研究。纳入至少有一个 NMOSD 核心临床特征的患者。记录并分析人口统计学和临床数据。使用 2015 年 IPND 和 2006 年标准对所有患者进行评估，使用 SPSS 分析数据。
结果
共纳入 110 例患者，91 例（82.72%）符合 2015 年 IPND 标准。在 91 例患者中，70 例 AQP4 抗体阳性，21 例阴性。在 110 例患者中，只有 30 例（27.2%）符合 2006 年标准（24 例或 80%为血清阳性）。2015 年标准在识别 61 例新 NMOSD 病例方面比 2006 年标准更敏感，差异具有统计学意义（P<0.05）。
结论
2015 年 IPND 标准比以前的 2006 年标准更敏感和特异，因为它涵盖了 NMOSD 的多种临床表现。应用这些标准，可以在单相疾病、孤立性复发性视神经炎、孤立性复发性脊髓炎、大脑综合征、间脑综合征、脑干综合征和后极综合征患者中诊断 NMOSD，从而提高诊断率。
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