Department of Neurology, The First Hospital of Shanxi Medical University, 85 Jiefang South Road, Taiyuan, Shanxi Province, China.
Department of Critical Care Medicine, Aerospace Center Hospital, 15 Yuquan Road, Beijing, China.
Mult Scler Relat Disord. 2023 Sep;77:104879. doi: 10.1016/j.msard.2023.104879. Epub 2023 Jul 8.
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a CNS demyelinating disease that targets myelin oligodendrocyte glycoprotein and recurs in approximately 50% of patients after the initial episode. Multiple relapses may have adverse consequences, but the factors influencing relapse are unclear. This study analyzed the clinical risk factors for relapse in patients with MOGAD.
Twenty-four MOGAD patients diagnosed at the Department of Neurology, First Hospital of Shanxi Medical University from March 2018 to November 2020 were retrospectively analyzed in this study. The patients were divided into a monophasic course and a relapsing course according to their disease process. The patients' epidemiological characteristics, clinical symptoms, laboratory tests, imaging features, and regression were summarized. Comparisons were made between the monophasic and relapsing course to identify the possible factors associated with the clinical features and recurrence.
At a mean follow-up of 15 months (range: 8 to 24 months), seventeen of the 24 patients (70.8%) had monophasic disease, and 7 (29.2%) had relapsing disease. Among the 24 patients, 17 patients (70.9%) had low Myelin oligodendrocyte glycoprotein antibody (MOG-IgG) serum titers (<1:100), and 7 patients (29.1%) had high MOG-IgG serum titers (≥1:100). Compared to the monophasic course group, patients in the relapsing course group had higher serum antibody titers (71.4% vs. 11.7%, P = 0.035). Onset phenotypes included encephalitis (50%), myelitis (45.8%), and optic neuritis (45.8%), with 66.7% of patients starting with a single phenotype and 33.3% starting with two or more phenotypes. Optic neuritis was more common in the relapsing course group (85.7%) than the monophasic course group (29.4%) (P = 0.023). There was no significant difference between the two groups in the proportion of myelitis and encephalitis. A previous history or background of immunological disease was present in 33.3% of patients, with a significantly higher proportion in the relapsing course group than in the monophasic course group (71.4% vs. 17.6%, P = 0.021). Regarding ancillary examinations, the relapsing course group was more likely to have CSF leukocytes higher than 50/mm than the monophasic course group (60% vs. 0, P = 0.045), while there was no difference in the number and site distribution of the lesions on MRI.
Our study suggests that the most common clinical manifestations of MOGAD are diminished visual acuity, limb/facial numbness, and ocular/orbital pain. The onset phenotype consisting of optic neuritis, a history of immune disease, high antibody titers (≥1:100), and high cerebrospinal fluid leukocytes (above 50/mm) suggests a high likelihood of MOGAD recurrence.
髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）是一种中枢神经系统脱髓鞘疾病，其靶标为髓鞘少突胶质细胞糖蛋白，约有 50%的患者在首次发作后复发。多次复发可能会产生不良后果，但影响复发的因素尚不清楚。本研究分析了 MOGAD 患者复发的临床危险因素。
回顾性分析 2018 年 3 月至 2020 年 11 月在山西医科大学第一医院神经内科确诊的 24 例 MOGAD 患者。根据病程将患者分为单相病程和复发病程。总结患者的流行病学特征、临床症状、实验室检查、影像学特征和转归。对单相和复发病程进行比较，以确定与临床特征和复发相关的可能因素。
平均随访 15 个月（范围：8 至 24 个月），24 例患者中 17 例（70.8%）为单相病程，7 例（29.2%）为复发病程。24 例患者中，17 例（70.9%）血清髓鞘少突胶质细胞糖蛋白抗体（MOG-IgG）滴度较低（<1:100），7 例（29.1%）血清 MOG-IgG 滴度较高（≥1:100）。与单相病程组相比，复发病程组患者的血清抗体滴度更高（71.4%比 11.7%，P=0.035）。起病表现包括脑炎（50%）、脊髓炎（45.8%）和视神经炎（45.8%），66.7%的患者以单一表型起病，33.3%的患者以两种或多种表型起病。视神经炎在复发病程组（85.7%）比单相病程组（29.4%）更常见（P=0.023）。两组间脊髓炎和脑炎的比例无显著差异。33.3%的患者既往或有免疫性疾病病史，复发病程组明显高于单相病程组（71.4%比 17.6%，P=0.021）。辅助检查方面，复发病程组脑脊液白细胞计数高于 50/mm 的比例高于单相病程组（60%比 0%，P=0.045），而 MRI 上的病灶数量和部位分布无差异。
本研究表明，MOGAD 最常见的临床表现为视力下降、四肢/面部麻木和眼部/眶部疼痛。起病表现为视神经炎、免疫性疾病病史、高抗体滴度（≥1:100）和高脑脊液白细胞计数（>50/mm）提示 MOGAD 复发的可能性较高。
