AQP4-IgG 血清阳性 NMOSD 患者存在亚临床定量视网膜层异常的证据。
Evidence of subclinical quantitative retinal layer abnormalities in AQP4-IgG seropositive NMOSD.
机构信息
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.
出版信息
Mult Scler. 2021 Oct;27(11):1738-1748. doi: 10.1177/1352458520977771. Epub 2020 Dec 14.
BACKGROUND
Prior studies have suggested that subclinical retinal abnormalities may be present in aquaporin-4 immunoglobulin G (AQP4-IgG) seropositive neuromyelitis optica spectrum disorder (NMOSD), in the absence of a clinical history of optic neuritis (ON).
OBJECTIVE
Our aim was to compare retinal layer thicknesses at the fovea and surrounding macula between AQP4-IgG+ NMOSD eyes without a history of ON (AQP4-nonON) and healthy controls (HC).
METHODS
In this single-center cross-sectional study, 83 AQP4-nonON and 154 HC eyes were studied with spectral-domain optical coherence tomography (OCT).
RESULTS
Total foveal thickness did not differ between AQP4-nonON and HC eyes. AQP4-nonON eyes exhibited lower outer nuclear layer (ONL) and inner photoreceptor segment (IS) thickness at the fovea (ONL: -4.01 ± 2.03 μm, = 0.049; IS: -0.32 ± 0.14 μm, = 0.029) and surrounding macula (ONL: -1.98 ± 0.95 μm, = 0.037; IS: -0.16 ± 0.07 μm, = 0.023), compared to HC. Macular retinal nerve fiber layer (RNFL: -1.34 ± 0.51 μm, = 0.009) and ganglion cell + inner plexiform layer (GCIPL: -2.44 ± 0.93 μm, = 0.009) thicknesses were also lower in AQP4-nonON compared to HC eyes. Results were similar in sensitivity analyses restricted to AQP4-IgG+ patients who had never experienced ON in either eye.
CONCLUSIONS
AQP4-nonON eyes exhibit evidence of subclinical retinal ganglion cell neuronal and axonal loss, as well as structural evidence of photoreceptor layer involvement. These findings support that subclinical anterior visual pathway involvement may occur in AQP4-IgG+ NMOSD.
背景
先前的研究表明，在没有视神经炎（ON）临床病史的情况下，水通道蛋白-4 免疫球蛋白 G（AQP4-IgG）阳性视神经脊髓炎谱系障碍（NMOSD）患者可能存在亚临床性视网膜异常。
目的
本研究旨在比较有 AQP4-IgG 但无 ON 病史（AQP4-nonON）的 NMOSD 眼和健康对照者（HC）的黄斑中心凹和周围视网膜层厚度。
方法
在这项单中心横断面研究中，使用频域光学相干断层扫描（OCT）对 83 只 AQP4-nonON 眼和 154 只 HC 眼进行了研究。
结果
AQP4-nonON 眼和 HC 眼的中心凹总厚度无差异。AQP4-nonON 眼的中心凹和周围黄斑的外核层（ONL）和内光感受器节段（IS）厚度较 HC 眼薄（ONL：-4.01±2.03 μm，=0.049；IS：-0.32±0.14 μm，=0.029），黄斑中心凹和周围黄斑的外核层（ONL：-1.98±0.95 μm，=0.037；IS：-0.16±0.07 μm，=0.023）。与 HC 眼相比，AQP4-nonON 眼的黄斑视网膜神经纤维层（RNFL：-1.34±0.51 μm，=0.009）和节细胞+内丛状层（GCIPL：-2.44±0.93 μm，=0.009）厚度也较低。在仅纳入双眼均从未发生过 ON 的 AQP4-IgG+患者的敏感性分析中，结果相似。
结论
AQP4-nonON 眼存在亚临床性视网膜节细胞神经元和轴突丢失的证据，以及光感受器层受累的结构证据。这些发现支持 AQP4-IgG+ NMOSD 可能存在亚临床性前视路受累。
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