Department of Neurology, Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University , Nanjing, China.
Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University , Nanjing, China.
Neurol Res. 2020 Jul;42(7):612-617. doi: 10.1080/01616412.2020.1773628. Epub 2020 Jun 4.
BACKGROUND/AIMS: Both of neuromyelitis optica spectrum disease (NMOSDs) and idiopathic transverse myelitis (ITM) could present as acute transverse myelitis. However, long-term immunological treatment and prognosis are different for high recurrence of NMOSDs. In this study, we summarized clinical differences between acute attack myelitis of NMOSDs and ITM, we further screened serum auto-antibodies to help understand the two distinct clinical entities.
This is a retrospective study on 48 NMOSD patients and 49 ITM patients in neurological department of Nanjing Drum Tower Hospital from 2013 to 2019. Clinical, CSF and MRI profiles on the acute episode were also compared between NMOSD patients and ITM patients. Serum AQP4 and auto-antibodies were tested. Clinical parameters were further compared between NMOSD patients with and without auto-antibodies.
Compared with ITM patients, NMOSD patients manifested with longer vertebral segments (5.42 ± 3.17 segments . 2.31 ± 2.36 segments, p < 0.001), higher female/male ratio (13:3 . 20:29, p < 0.001), higher IgG index (30.30% . 9.09%, p < 0.05). Positive rates of anti-Ro-52 (47.92% . 14.29%, p < 0.001), anti-ANAs (50.00% .10.20%, p < 0.001) and anti-SSA (35.42% . 6.12%, p = 0.001) were significantly higher in the NMOSD patients than the ITM patients. Seropositive Ro-52 and SSA were associated with longer injured spinal cord segments. However, Ro-52 antibody may not be associated with NMOSD relapsing during our follow up.
NMOSD patients manifested with longer vertebral segments, higher female/male ratio, IgG index, anti-ANAs, anti-Ro-52 and anti-SSA seroprevalence than ITM patients. These features may help clinicians better distinguish NMOSD from ITM and provide long-term immunotherapy reasonably.
背景/目的：视神经脊髓炎谱系疾病（NMOSD）和特发性横贯性脊髓炎（ITM）均可表现为急性横贯性脊髓炎。然而，NMOSD 具有较高的复发率，需要长期免疫治疗和预后不同。在本研究中，我们总结了 NMOSD 急性发作性脊髓炎与 ITM 的临床差异，进一步筛选血清自身抗体，以帮助了解这两种不同的临床实体。
这是一项回顾性研究，纳入了 2013 年至 2019 年在南京鼓楼医院神经内科就诊的 48 例 NMOSD 患者和 49 例 ITM 患者。比较 NMOSD 患者和 ITM 患者急性发作时的临床、CSF 和 MRI 特征。检测血清 AQP4 和自身抗体。进一步比较 NMOSD 患者自身抗体阳性和阴性患者的临床参数。
与 ITM 患者相比，NMOSD 患者的受累椎体节段更长（5.42±3.17 个节段比 2.31±2.36 个节段，p<0.001），女性/男性比例更高（13:3 比 20:29，p<0.001），IgG 指数更高（30.30%比 9.09%，p<0.05）。NMOSD 患者抗 Ro-52（47.92%比 14.29%，p<0.001）、抗核抗体（ANA）（50.00%比 10.20%，p<0.001）和抗 SSA（35.42%比 6.12%，p=0.001）的阳性率显著高于 ITM 患者。血清阳性的 Ro-52 和 SSA 与更长的损伤脊髓节段相关。然而，在我们的随访中，Ro-52 抗体与 NMOSD 复发无关。
与 ITM 患者相比，NMOSD 患者的受累椎体节段更长、女性/男性比例更高、IgG 指数更高、抗 ANA、抗 Ro-52 和抗 SSA 抗体阳性率更高。这些特征可能有助于临床医生更好地区分 NMOSD 和 ITM，并合理提供长期免疫治疗。
