与血清 MO G-IgG 相关的首发脱髓鞘事件的诊断特征。

Diagnostic features of initial demyelinating events associated with serum MOG-IgG.

机构信息

Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.

出版信息

J Neuroimmunol. 2020 Jul 15;344:577260. doi: 10.1016/j.jneuroim.2020.577260. Epub 2020 May 7.

DOI:10.1016/j.jneuroim.2020.577260

PMID:32442864

Abstract

BACKGROUND

Myelin oligodendrocyte glycoprotein (MOG)-IgG associated disorders are increasingly recognized as a distinct disease entity. However, diagnostic sensitivity and specificity of serum MOG-IgG as well as recommendations for testing are still debated.

MATERIALS AND METHODS

Between October 2015 and July 2017 we tested serum MOG-IgG in 91 adult patients (49 females) with a demyelinating event (DE) not fulfilling 2010 McDonald criteria for MS at sampling, negative for neuromyelitis optica (NMO)-IgG and followed-up for at least 12 months. We assessed the sensitivity and specificity of a live-cell MOG-IgG assay for each final diagnosis at last follow-up, for the 2018 international recommendations for MOG-IgG testing, and for other combinations of clinical and laboratory characteristics.

RESULTS

Clinical presentations included acute myelitis (n = 48), optic neuritis (n = 36), multifocal encephalomyelitis (n = 4), and brainstem syndrome (n = 3). Twenty-four patients were MOG-IgG positive. Sensitivity and specificity of MOG-IgG test applied to the 2018 international recommendations were 28.4% and 86.7%, while they were 42.1% and 88.6% when applied to DE of unclear aetiology as defined above with two or more among: 1_no periventricular and juxtacortical MS-like lesions on brain MRI; 2_longitudinally extensive MRI optic nerve lesion; 3_no CSF-restricted oligoclonal bands; 4_CSF protein > 50 mg/dl.

CONCLUSIONS

Simplified requirements compared to those currently proposed for MOG-IgG testing could facilitate the applicability of the assay in the diagnosis of adults with DEs of unclear aetiology.

摘要

背景

髓鞘少突胶质细胞糖蛋白（MOG）-IgG 相关疾病作为一种独特的疾病实体，越来越受到人们的认识。然而，血清 MOG-IgG 的诊断敏感性和特异性以及检测建议仍存在争议。

材料和方法

我们在 2015 年 10 月至 2017 年 7 月间，对 91 名成年患者（49 名女性）的血清 MOG-IgG 进行了检测，这些患者在采样时存在脱髓鞘事件（DE）但不符合 2010 年 McDonald 多发性硬化症标准，抗 NMO-IgG 检测为阴性，并进行了至少 12 个月的随访。我们评估了在最后一次随访时，基于每种最终诊断的活细胞 MOG-IgG 检测的敏感性和特异性，以及 2018 年 MOG-IgG 检测的国际推荐，以及其他临床和实验室特征的组合。

结果

临床表现包括急性脊髓炎（n=48）、视神经炎（n=36）、多灶性脑脊髓炎（n=4）和脑干综合征（n=3）。24 名患者 MOG-IgG 阳性。MOG-IgG 检测应用于 2018 年国际推荐的敏感性和特异性分别为 28.4%和 86.7%，而应用于上述病因不明的 DE 时，敏感性和特异性分别为 42.1%和 88.6%，其特征为：1.脑 MRI 无脑室周围和皮质下 MS 样病变；2.视神经 MRI 病变纵向延伸范围大；3.CSF 无寡克隆带限制；4.CSF 蛋白>50mg/dl。