Gupta Salil, Rehani Varun, Dhull Pawan, Somasekharan Manoj, Sreen Amit
Department of and Neurology, Army Hospital Research and Referral, Delhi Cantt, New Delhi, India.
Ann Indian Acad Neurol. 2022 Mar-Apr;25(2):239-245. doi: 10.4103/aian.aian_406_21. Epub 2022 Feb 9.
Study was conducted with aim of comparing subtypes types of NMOSD based on serology.
In this retrospective study, patients ≥18 years were included satisfying IPND 2015 criteria. Three groups were created based on seropositivity for AQP4 antibody, MOG antibody or double seronegative. Demographic, clinical and imaging were compared using regression analysis.
Forty-six patients, 28 (60.9%) AQP4+, 11 (23.9%) MOG + and remaining 7 (15.2%) double seronegative were included. Thirty-seven patients (80.4%) had presenting symptoms localized to optic nerve and/or cord [AQP4 + 22 (78.5%), MOG + 9 (81.8%) and double seronegative 6 (85.7%)]. Presentation with bilateral optic neuritis was more common in AQP4- patients. Twenty (86.8%) out of the 23 patients who had relapsing disease localized to optic nerve and/or spinal cord [AQP4 + 13/14 (92.8%), MOG + 3/5 (60%) and double seronegative 4/4 (100%)]. Relapses were more common in AQP4+ (77% vs 12% vs10%). In AQP4 negative group disability (EDSS 4.2 vs 3.3) and progression index was relatively less (1.6 vs 1.1). CSF pleocytosis (38.8% vs 17.9%) and raised proteins (66.6% vs 32.1%) were also more common. Optic nerve MRI (>50% optic nerve and chiasma involvement) was more commonly abnormal in AQP4 negative (52.9% vs 31.2%). Regression analysis revealed females to be significantly higher in AQP4 positive NMOSD (89.3%) when compared to MOG positive (36.4%) and double seronegative (42.9%).
Gender was the only significant difference between the three groups. There was trend towards greater disability and more relapses in AQP4 + groups.
开展本研究旨在基于血清学比较视神经脊髓炎谱系障碍（NMOSD）的亚型。
在这项回顾性研究中，纳入年龄≥18岁且符合2015年国际神经病学联盟（IPND）标准的患者。根据水通道蛋白4（AQP4）抗体、髓鞘少突胶质细胞糖蛋白（MOG）抗体血清学阳性或双阴性分为三组。使用回归分析比较人口统计学、临床和影像学特征。
共纳入46例患者，其中28例（60.9%）AQP4抗体阳性，11例（23.9%）MOG抗体阳性，其余7例（15.2%）双阴性。37例患者（80.4%）首发症状局限于视神经和/或脊髓[AQP4抗体阳性组22例（78.5%），MOG抗体阳性组9例（81.8%），双阴性组6例（85.7%）]。双侧视神经炎在AQP4抗体阴性患者中更常见。在23例复发性疾病局限于视神经和/或脊髓的患者中，20例（86.8%）[AQP4抗体阳性组13/14例（92.8%），MOG抗体阳性组3/5例（60%），双阴性组4/4例（100%）]。复发在AQP4抗体阳性组更常见（77%对12%对10%）。在AQP4抗体阴性组，残疾程度（扩展残疾状态量表[EDSS]评分4.2对3.3）和疾病进展指数相对较低（1.6对1.1）。脑脊液细胞增多（38.8%对17.9%）和蛋白升高（66.6%对32.1%）也更常见。视神经磁共振成像（MRI）（视神经和视交叉受累>50%）在AQP4抗体阴性组更常出现异常（52.9%对31.2%）。回归分析显示，与MOG抗体阳性组（36.4%）和双阴性组（42.9%）相比，AQP4抗体阳性的NMOSD患者中女性比例显著更高（89.3%）。
三组之间唯一的显著差异是性别。AQP4抗体阳性组有残疾程度更高和复发更多的趋势。
