AQP4-IgG 阳性视神经脊髓炎谱系疾病中的黄斑改变。
Altered fovea in AQP4-IgG-seropositive neuromyelitis optica spectrum disorders.
机构信息
From the Experimental and Clinical Research Center (S.M., F.C.O., J.B.-S., H.G.Z., F.P., A.U.B.), Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; NeuroCure Clinical Research Center (S.M., F.C.O., S.K.Y., E.M.K., J.B.-S., H.G.Z., F.P., A.U.B.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Division of Neuroinflammation and Glial Biology (F.C.O.), University of California, San Francisco; Nocturne GmbH (S.K.Y., E.M.K.), Berlin; Department of Neurology (M.W., M.R., O.A., P.A.), Medical Faculty, Heinrich Heine University, Düsseldorf; Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University, Munich; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf; Department of Neurology (K.R., F.P.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; and Department of Neurology (A.U.B.), University of California, Irvine.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2020 Jun 23;7(5). doi: 10.1212/NXI.0000000000000805. Print 2020 Sep.
OBJECTIVE
To investigate disease-specific foveal shape changes in patients with neuromyelitis optica spectrum disorders (NMOSDs) using foveal morphometry.
METHODS
This cross-sectional study included macular spectral domain optical coherence tomography scans of 52 eyes from 28 patients with aquaporin-4 immunoglobulin G (AQP4-IgG)-seropositive NMOSD, 116 eyes from 60 patients with MS, and 123 eyes from 62 healthy controls (HCs), retrospectively, and an independent confirmatory cohort comprised 33/33 patients with NMOSD/MS. The fovea was characterized using 3D foveal morphometry. We included peripapillary retinal nerve fiber layer (pRNFL) thickness and combined macular ganglion cell and inner plexiform layer (GCIPL) volume to account for optic neuritis (ON)-related neuroaxonal damage.
RESULTS
Group comparison showed significant differences compared with HC in the majority of foveal shape parameters in NMOSD, but not MS. Pit flat disk area, average pit flat disk diameter, inner rim volume, and major slope disk length, as selected parameters, showed differences between NMOSD and MS ( value = 0.017, 0.002, 0.005, and 0.033, respectively). This effect was independent of ON. Area under the curve was between 0.7 and 0.8 (receiver operating characteristic curve) for discriminating between NMOSD and MS. Pit flat disk area and average pit flat disk diameter changes independent of ON were confirmed in an independent cohort.
CONCLUSIONS
Foveal morphometry reveals a wider and flatter fovea in NMOSD in comparison to MS and HC. Comparison to MS and accounting for ON suggest this effect to be at least in part independent of ON. This supports a primary retinopathy in AQP4-IgG-seropositive NMOSD.
目的
通过黄斑形态计量学研究视神经脊髓炎谱系疾病（NMOSD）患者的疾病特异性黄斑中心凹形态变化。
方法
本横断面研究回顾性纳入了 28 例水通道蛋白 4 免疫球蛋白 G（AQP4-IgG）阳性 NMOSD 患者的 52 只眼、60 例多发性硬化（MS）患者的 116 只眼和 62 名健康对照者（HC）的 123 只眼的黄斑区光谱域光学相干断层扫描图像，同时还纳入了一个由 33/33 例 NMOSD/MS 患者组成的独立验证队列。使用 3D 黄斑形态计量学对黄斑中心凹进行特征描述。我们纳入了视盘周围视网膜神经纤维层（pRNFL）厚度和联合黄斑神经节细胞和内丛状层（GCIPL）体积来评估视神经炎（ON）相关的神经轴突损伤。
结果
与 HC 相比，NMOSD 组的大多数黄斑中心凹形态参数均存在显著差异，但 MS 组无此差异。盘形凹陷面积、平均盘形凹陷直径、内环体积和主要斜率盘长度等选定参数在 NMOSD 和 MS 之间存在差异（ 值分别为 0.017、0.002、0.005 和 0.033）。这种差异独立于 ON。区分 NMOSD 和 MS 的曲线下面积在 0.7 到 0.8 之间（ROC 曲线）。在独立队列中证实了独立于 ON 的盘形凹陷面积和平均盘形凹陷直径的变化。
结论
与 MS 和 HC 相比，NMOSD 的黄斑中心凹更宽更平。与 MS 相比并考虑到 ON 的影响，这表明这种影响至少部分独立于 ON。这支持了 AQP4-IgG 阳性 NMOSD 存在原发性视网膜病变。
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