Department of Neurology, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Japan; Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.
Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan.
J Neurol Sci. 2023 Sep 15;452:120742. doi: 10.1016/j.jns.2023.120742. Epub 2023 Jul 24.
Electrolyte disorders are among the important conditions negatively affecting the disease course of neuromyelitis optica spectrum disorder (NMOSD). Possible mechanisms may include renal tubular acidosis (RTA) accompanying Sjögren's syndrome (SS), syndrome of inappropriate antidiuretic hormone secretion (SIADH), and central diabetes insipidus (DI). Currently, the overlap profiles between these conditions remain uncertain.
This cross-sectional study collected data from the nationwide administrative Diagnosis Procedure Combination (DPC) database and evaluated the overlap profiles.
Among the 28,285,908 individuals from 1203 DPC-covered hospitals, 8477 had NMOSD, 174108 had SS, 4977 had RTA, 7640 had SIADH, and 24,789 had central DI. Of those with NMOSD, 986 (12%) had SS. The odds ratio (OR) for a diagnosis of NMOSD in those with SS compared with those without was 21 [95% confidence interval (CI), 20-23]. Overlap between NMOSD and SS was seen both in males (OR, 28 [95% CI, 23-33]) and females (OR, 16 [15-17]) and was more prominent in the younger population. Among patients with SS, the prevalence of RTA was lower in patients with NMOSD compared with those without NMOSD. Patients with NMOSD showed a higher prevalence of SIADH (OR, 11 [7.5-17]; p < 0.0001) and DI (OR, 3.7 [2.4-5.3]; p < 0.0001). Comorbid SS in NMOSD was associated with a higher prevalence of DI.
Patients with NMOSD are likely to have SS, SIADH, and central DI. RTA in SS does not facilitate the overlap between NMOSD and SS. SS in NMOSD may predispose patients to DI.
电解质紊乱是影响视神经脊髓炎谱系疾病（NMOSD）病程的重要因素之一。可能的机制包括伴发干燥综合征（SS）的肾小管酸中毒（RTA）、抗利尿激素分泌不当综合征（SIADH）和中枢性尿崩症（DI）。目前，这些疾病之间的重叠表现尚不确定。
本横断面研究从全国性行政诊断程序组合（DPC）数据库中收集数据并进行评估。
在来自 1203 家 DPC 覆盖医院的 28285908 人中，8477 人患有 NMOSD，174108 人患有 SS，4977 人患有 RTA，7640 人患有 SIADH，24789 人患有中枢性 DI。NMOSD 患者中有 986 人（12%）患有 SS。与无 SS 的 NMOSD 患者相比，SS 患者 NMOSD 的诊断比值比（OR）为 21[95%置信区间（CI），20-23]。NMOSD 和 SS 之间的重叠在男性（OR，28[95%CI，23-33]）和女性（OR，16[15-17]）中均可见，且在年轻人群中更为明显。在 SS 患者中，NMOSD 患者的 RTA 患病率低于无 NMOSD 的患者。NMOSD 患者的 SIADH（OR，11[7.5-17]；p<0.0001）和 DI（OR，3.7[2.4-5.3]；p<0.0001）患病率更高。NMOSD 合并 SS 与 DI 患病率较高相关。
NMOSD 患者可能患有 SS、SIADH 和中枢性 DI。SS 中的 RTA 并不促进 NMOSD 和 SS 之间的重叠。NMOSD 中的 SS 可能使患者易患 DI。
