Department of Neurology, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea; Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea; Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Mult Scler Relat Disord. 2020 May;40:101981. doi: 10.1016/j.msard.2020.101981. Epub 2020 Feb 4.
Altered lipid metabolism is a feature of systemic autoimmune diseases. Dyslipidemia is associated with the disease activity and progression in patients with multiple sclerosis. However, in neuromyelitis optica spectrum disorder (NMOSD), changes in the lipid profile and the associations between specific lipid levels and disease activity/disability are unknown.
Serum samples (N = 148) were collected from 53 patients with aquaporin-4 (AQP4)-positive NMOSD when they were not treated with lipid lowering agents. Fasting lipid (total cholesterol, triglyceride [TG], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol) levels were compared between 39 patients with NMOSD, not taking steroids, and 142 age-, sex-, and body mass index-matched healthy controls. In addition, we analyzed the differences in the lipid profile between attack and remission samples and the associations between lipid profiles and clinical outcome in all 148 samples from 53 patients. The generalized estimating equation was used.
Patients with NMOSD showed lower HDL-C and higher TG levels compared to healthy controls (p = 0.017 and p < 0.001, respectively). HDL-C level was significantly lower during attack than remission (β = -7.851; p = 0.035), and TG level had positive correlation with EDSS scores (β = 0.014; p = 0.002) regardless of disease activity status. However, enhanced lesions on magnetic resonance imaging were not associated with lipid profiles.
Dyslipidemia with low HDL-C and high TG correlated disease activity and disability in AQP4-positive NMOSD. It remains to be elucidated whether altered lipid metabolism contributes to deleterious immune response, possibly through inflammation, or is secondary to neurological disability in NMOSD.
脂质代谢异常是系统性自身免疫性疾病的特征。血脂异常与多发性硬化症患者的疾病活动度和进展相关。然而，在视神经脊髓炎谱系疾病（NMOSD）中，脂质谱的变化以及特定脂质水平与疾病活动/残疾之间的关系尚不清楚。
在未使用降脂药物治疗的情况下，收集了 53 例水通道蛋白-4（AQP4）阳性 NMOSD 患者的血清样本（N=148）。比较了 39 例未服用类固醇的 NMOSD 患者和 142 名年龄、性别和体重指数匹配的健康对照者的空腹血脂（总胆固醇、甘油三酯[TG]、高密度脂蛋白胆固醇[HDL-C]、低密度脂蛋白胆固醇）水平。此外，我们分析了所有 53 例患者的 148 个样本中，攻击期和缓解期样本的脂质谱差异，以及所有 148 个样本中脂质谱与临床结局之间的相关性。采用广义估计方程进行分析。
与健康对照组相比，NMOSD 患者的 HDL-C 水平较低，TG 水平较高（p=0.017 和 p<0.001）。与缓解期相比，攻击期的 HDL-C 水平显著降低（β=-7.851；p=0.035），无论疾病活动状态如何，TG 水平与 EDSS 评分均呈正相关（β=0.014；p=0.002）。然而，增强的磁共振成像病变与脂质谱无关。
AQP4 阳性 NMOSD 中，血脂异常伴低 HDL-C 和高 TG 与疾病活动度和残疾相关。改变的脂质代谢是否通过炎症导致有害的免疫反应，或者是否继发于 NMOSD 的神经功能障碍，仍有待阐明。
