Liu Jia, Tan Guojun, Li Bin, Zhang Jingze, Gao Ying, Cao Yuanbo, Jia Zhen, Sugimoto Kazuo
Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.
Front Neurol. 2021 Oct 20;12:746959. doi: 10.3389/fneur.2021.746959. eCollection 2021.
Aquaporin 4-immunoglobulin G (AQP4-IgG) plays a major role in the pathogenesis of neuromyelitis optica spectrum disorder (NMOSD). Seropositive status for this antibody has become one of the required indicators for NMOSD diagnosis. Our goal was to systematically review and perform a meta-analysis of the current works of literature evaluating the clinical relevance of serum AQP4-IgG titer in patients with NMOSD. We sought to determine whether AQP4-IgG could indicate disease activity or severity, in addition to its diagnostic value in NMOSD. Electronic databases were searched for published literature, yielding 4,402 hits. Of the 124 full articles screened, 17 were included in the qualitative analysis and 14 in the meta-analysis. There were no significant differences in serum AQP4-IgG titers between the relapse and remission phases in patients with NMOSD [standard mean difference (SMD): 0.32, 95% CI (-0.10, 0.74), = 0.14]. Subgroup meta-analysis of AQP4-IgG detected by cell-based assays (CBA), an AQP4-IgG testing method recommended by the 2015 international consensus diagnostic criteria for NMOSD, confirmed the aforementioned result [SMD: 0.27, 95% CI (-0.01, 0.55), = 0.06]. Moreover, the serum AQP4-IgG titer was positively correlated with the number of involved spinal cord segments [correlation coefficient (COR): 0.70, 95% CI (0.28-0.89), = 0.003] and the Expanded Disability Status Scale (EDSS) score [COR: 0.54, 95% CI (0.06-0.82), = 0.03] in the attack phase in patients with NMOSD. The present study systematically assessed the association between serum AQP4-IgG titer and NMOSD activity and severity. The results demonstrated that the serum AQP4-IgG titer was not associated with disease activity but indicated the disease severity in the attack phase in patients with NMOSD. A further meta-analysis with a larger number of studies that employed standardized AQP4-IgG assays and detected attack-remission paired samples from the same patients with detailed medication information will be required to confirm our findings and shed more light on optimizing clinical AQP4-IgG monitoring. [www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=208209], PROSPERO, identifier [CRD42020208209].
水通道蛋白4-免疫球蛋白G（AQP4-IgG）在视神经脊髓炎谱系障碍（NMOSD）的发病机制中起主要作用。该抗体血清阳性状态已成为NMOSD诊断的必要指标之一。我们的目标是系统评价并对当前评估NMOSD患者血清AQP4-IgG滴度临床相关性的文献进行荟萃分析。我们试图确定AQP4-IgG除了在NMOSD中的诊断价值外，是否还能指示疾病活动或严重程度。检索电子数据库中的已发表文献，共获得4402条结果。在筛选的124篇全文中，17篇纳入定性分析，14篇纳入荟萃分析。NMOSD患者复发期和缓解期的血清AQP4-IgG滴度无显著差异[标准均数差（SMD）：0.32，95%置信区间（-0.10，0.74），P = 0.14]。基于细胞的检测方法（CBA）是2015年NMOSD国际共识诊断标准推荐的AQP4-IgG检测方法，对其进行的亚组荟萃分析证实了上述结果[SMD：0.27，95%置信区间（-0.01，0.55），P = 0.06]。此外，NMOSD患者发作期血清AQP4-IgG滴度与受累脊髓节段数[相关系数（COR）：0.70，95%置信区间（0.28 - 0.89），P = 0.003]和扩展残疾状态量表（EDSS）评分[COR：0.54，95%置信区间（0.06 - 0.82），P = 0.03]呈正相关。本研究系统评估了血清AQP4-IgG滴度与NMOSD活动及严重程度之间的关联。结果表明，血清AQP4-IgG滴度与疾病活动无关，但可指示NMOSD患者发作期的疾病严重程度。需要进行进一步的荟萃分析，纳入更多采用标准化AQP4-IgG检测方法并检测同一患者发作-缓解配对样本且有详细用药信息的研究，以证实我们的发现，并进一步明确优化临床AQP4-IgG监测的方法。[www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=208209]，PROSPERO，标识符[CRD42020208209]
