Etemadifar Masoud, Chitsaz Ahmad, Rajabkhah Sahebeh, Tavakoli Hossein, Shafieyoun Arezoo, Noorshargh Pegah, Afzali Mahdieh
Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Curr J Neurol. 2020 Oct 6;19(4):173-179. doi: 10.18502/cjn.v19i4.5544.
The aim of this study was to evaluate the status of anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in patients with transverse myelitis (TM) and compare the clinical and imaging characteristics of MOG immunoglobulin G (IgG)-positive with negative cases. This cohort study enrolled 71 patients diagnosed with new-onset of TM who were being followed at a referral university clinic in Isfahan, Iran, from November 2016 to January 2019. Magnetic resonance imaging (MRI) images and blood samples for anti-MOG, anti-aquaporin 4 (anti-AQP4) (using the cell-based technique), and vasculitis-related antibodies were collected from patients. Outcomes were assessed by the evolution of the Expanded Disability Status Scale (EDSS) score and brain and spinal cord imaging findings within three months. All patients underwent imaging and clinical assessment during a mean period of one year as a follow-up. We compared the characteristics of clinical and radiological outcomes in MOG-IgG-positive and negative cases. Of the total population studied, there were 26.8% men and 73.2% women, with a mean age of 33 ± 10 years. 12 (16.9%) patients were seropositive for MOG antibody and 17 (89.5%) were positive for anti-AQP4 antibodies. There was no significant association between anti-MOG antibody seropositivity and age, gender distribution, the presence of other autoimmune diseases, and number and interval of relapses. However, the involvement site of the spine at first imaging was significantly different between seronegative and seropositive patients. In patients with MOG antibody disease (MOG-AD) TM, the MRI findings suggest a preferential involvement of the cervical-thoracic section in seropositive cases which may help differentiate from non-MOG demyelination TM.
本研究旨在评估横贯性脊髓炎（TM）患者中抗髓鞘少突胶质细胞糖蛋白（MOG）抗体的状况，并比较MOG免疫球蛋白G（IgG）阳性与阴性病例的临床和影像学特征。这项队列研究纳入了2016年11月至2019年1月在伊朗伊斯法罕一所转诊大学诊所接受随访的71例诊断为新发TM的患者。收集了患者的磁共振成像（MRI）图像以及用于检测抗MOG、抗水通道蛋白4（抗AQP4）（采用基于细胞的技术）和血管炎相关抗体的血样。通过三个月内扩展残疾状态量表（EDSS）评分的变化以及脑和脊髓成像结果来评估结局。所有患者在平均一年的随访期内接受了影像学和临床评估。我们比较了MOG-IgG阳性和阴性病例的临床和放射学结局特征。在整个研究人群中，男性占26.8%，女性占73.2%，平均年龄为33±10岁。12例（16.9%）患者MOG抗体血清学阳性，17例（89.5%）患者抗AQP4抗体阳性。抗MOG抗体血清学阳性与年龄、性别分布、其他自身免疫性疾病的存在以及复发次数和间隔时间之间无显著关联。然而，血清阴性和血清阳性患者首次成像时脊柱的受累部位存在显著差异。在MOG抗体病（MOG-AD）型TM患者中，MRI表现提示血清阳性病例中颈胸段更易受累，这可能有助于与非MOG脱髓鞘性TM相鉴别。
