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[伴有结缔组织病的视神经脊髓炎谱系障碍的临床特征]

[Clinical Features of Neuromyelitis Optica Spectrum Disorders with Connective Tissue Diseases].

作者信息

Xie Jia Yi, Chen Xiao Qing, Zhou Ming Xuan, Ye Li Chao

机构信息

Department of Rheumatology,The Second Affiliated Hospital of Fujian Medical University,Quanzhou,Fujian 362000,China.

Department of Neurology,The Second Affiliated Hospital of Fujian Medical University,Quanzhou,Fujian 362000,China.

出版信息

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2021 Apr 28;43(2):159-165. doi: 10.3881/j.issn.1000-503X.12854.

Abstract

Objective To investigate the clinical features of neuromyelitis optica spectrum disorders(NMOSD)with connective tissue diseases(CTD). Methods Clinical data of 16 NMOSD-CTD patients and 54 NMOSD patients admitted to the Second Affiliated Hospital of Fujian Medical University from January 2015 to February 2020 were collected.The initial symptom,intracranial lesion,spinal cord lesion,laboratory examination and treatment response were compared between the two groups. Results The incidence of Sjögren's syndrome(SS)was the highest(10/16,62.5%)in NMOSD-CTD group.The NMOSD-CTD group had significantly higher positive rate of aquaporin-4 immunoglobulin G(AQP4-IgG)in serum or cerebrospinal fluid(100% vs. 70.2%,P=0.009),higher positive rates of serum anti-nuclear antibodies,anti Sjögren's syndrome A antibodies and anti-Ro52 autoantibodies(P<0.001),as well as higher proportion of patients with the expanded disability status scale score ≥ 6(50.0% vs. 22.2%,P=0.035)than the NMOSD group.There was no significant difference between the two groups in the age of onset,visiting age,recurrence frequency,disease course,distribution of intracranial lesions,spinal cord involvement,or the effective rate of glucocorticoid pulse therapy(all P>0.05).Conclusions NMOSD is often complicated with CTD,and SS is the most common one.The positive rate of serum or cerebrospinal AQP4-IgG and the seropositivity of several other autoantibodies in NMOSD-CTD patients were higher than those in NMOSD patients.Neurological impairment in NMOSD-CTD patients were severer,which should arouse attention of clinicians.

摘要

目的 探讨合并结缔组织病(CTD)的视神经脊髓炎谱系障碍(NMOSD)的临床特征。方法 收集2015年1月至2020年2月福建医科大学附属第二医院收治的16例NMOSD-CTD患者和54例NMOSD患者的临床资料。比较两组患者的首发症状、颅内病变、脊髓病变、实验室检查及治疗反应。结果 NMOSD-CTD组中干燥综合征(SS)的发生率最高(10/16,62.5%)。NMOSD-CTD组血清或脑脊液中水通道蛋白4免疫球蛋白G(AQP4-IgG)阳性率显著高于NMOSD组(100% 对70.2%,P=0.009),血清抗核抗体、抗干燥综合征A抗体和抗Ro52自身抗体阳性率更高(P<0.001),且扩展残疾状态量表评分≥6分的患者比例高于NMOSD组(50.0% 对22.2%,P=0.035)。两组患者在发病年龄、就诊年龄、复发次数、病程、颅内病变分布、脊髓受累情况或糖皮质激素冲击治疗有效率方面比较,差异均无统计学意义(均P>0.05)。结论 NMOSD常合并CTD,其中SS最为常见。NMOSD-CTD患者血清或脑脊液AQP4-IgG阳性率及其他几种自身抗体的血清学阳性率高于NMOSD患者。NMOSD-CTD患者神经功能损害更严重,应引起临床医生的重视。

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