Yao Yaobing, Yang Xuan, Zhou Yongyan, Xie Haojie, Duan Ranran, Jing Lijun, Li Yanfei, Guan Wenjuan, Teng Junfang, Jia Yanjie
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Neurol. 2022 Aug 25;13:969762. doi: 10.3389/fneur.2022.969762. eCollection 2022.
The coexistence of neuromyelitis optica spectrum disorder (NMOSD) and connective tissue disease (CTD) is well recognized. The purpose of this study was to investigate and compare the characteristics of first attack NMOSD with and without CTD.
A total of 113 Patients with NMOSD were included and were divided into two groups based on the presence of co-occurring CTD. Their demographic, clinical, laboratory, and image characteristics were obtained through inpatient medical records and follow-ups. Kaplan-Meier survival analysis was used to analyze the effect of CTD in NMOSD patients at the time of first recurrence. The risk factors that could predict complications of NMOSD with CTD was analyzed by binary logistic regression. The ability of homocysteine (Hcy) to predict the coexistence of NMOSD and CTD was analyzed and evaluated by the receiver operating characteristic curve.
The demographic data, clinical features, cerebrospinal fluid analysis, and MRI findings, except relapse events (including relapse rate, number of recurrences, and time of first recurrence), were similar between the two groups. The serum lymphocyte-to-monocyte ratio and albumin levels were lower ( < 0.05), while serum erythrocyte sedimentation rate and Hcy levels were higher in patients with NMOSD with CTD than in those without CTD ( < 0.001). Kaplan-Meier survival analysis showed that the time of first recurrence in NMOSD patients complicated with CTD was earlier than that of without CTD (log rank test = 0.035). Logistic regression revealed that serum Hcy levels (OR 1.296, 95% CI, 1.050-1.601, = 0.016) were independently associated with the occurrence of NMOSD with CTD. The receiver operating characteristic curve area was 0.738 (95% CI, 0.616-0.859; < 0.001) for Hcy levels. Considering the Hcy concentration of 14.07 μmol/L as the cutoff value, the sensitivity and specificity of predicting the coexistence of first-attack NMOSD and CTD were 56 and 89.8%, respectively.
When the first-attack NMOSD patients are complicated with CTD, they have a higher recurrence rate, more recurrences, earlier first recurrence, higher serum Hcy levels, and enhanced systemic inflammatory reactions. Furthermore, Hcy levels may help to screen for CTD in patients with first-attack NMOSD.
视神经脊髓炎谱系障碍（NMOSD）与结缔组织病（CTD）共存已得到充分认识。本研究的目的是调查和比较初发时合并或不合并CTD的NMOSD的特征。
共纳入113例NMOSD患者，并根据是否合并CTD分为两组。通过住院病历和随访获取他们的人口统计学、临床、实验室和影像特征。采用Kaplan-Meier生存分析来分析CTD对NMOSD患者首次复发时的影响。通过二元逻辑回归分析可预测合并CTD的NMOSD并发症的危险因素。通过受试者工作特征曲线分析和评估同型半胱氨酸（Hcy）预测NMOSD和CTD共存的能力。
两组之间的人口统计学数据、临床特征、脑脊液分析和MRI表现相似，但复发事件（包括复发率、复发次数和首次复发时间）除外。合并CTD的NMOSD患者的血清淋巴细胞与单核细胞比值和白蛋白水平较低（<0.05），而血清红细胞沉降率和Hcy水平高于未合并CTD的患者（<0.001）。Kaplan-Meier生存分析显示，合并CTD的NMOSD患者首次复发时间早于未合并CTD的患者（对数秩检验=0.035）。逻辑回归显示，血清Hcy水平（OR 1.296，95%CI，1.050-1.601，=0.016）与合并CTD的NMOSD的发生独立相关。Hcy水平的受试者工作特征曲线面积为0.738（95%CI，0.616-0.859；<0.001）。以Hcy浓度14.07μmol/L为临界值，预测初发NMOSD和CTD共存的敏感性和特异性分别为56%和89.8%。
初发时合并CTD的NMOSD患者复发率更高、复发次数更多、首次复发更早、血清Hcy水平更高且全身炎症反应增强。此外，Hcy水平可能有助于筛查初发NMOSD患者中的CTD。
