全身炎症反应指数是区分 MOGA 与 AQP4-IgG 阳性 NMOSD 的有用指标。
Systemic inflammation response index is a useful indicator in distinguishing MOGAD from AQP4-IgG-positive NMOSD.
机构信息
Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
出版信息
Front Immunol. 2024 Jan 8;14:1293100. doi: 10.3389/fimmu.2023.1293100. eCollection 2023.
OBJECTIVE
To identify reliable immune-inflammation indicators for distinguishing myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) from anti-aquaporin-4 immunoglobulin G (AQP4-IgG)-positive neuromyelitis optica spectrum disorders (NMOSD). To assess these indicators' predictive significance in MOGAD recurrence.
METHODS
This study included 25 MOGAD patients, 60 AQP4-IgG-positive NMOSD patients, and 60 healthy controls (HCs). Age and gender were matched among these three groups. Participant clinical and imaging findings, expanded disability status scale (EDSS) scores, cerebrospinal fluid (CSF) information, and blood cell counts were documented. Subsequently, immune-inflammation indicators were calculated and compared among the MOGAD, AQP4-IgG-positive NMOSD, and HC groups. Furthermore, we employed ROC curve analysis to assess the predictive performance of each indicator and binary logistic regression analysis to assess potential risk factors.
RESULTS
In MOGAD patients, systemic inflammation response index (SIRI), CSF white cell count (WCC), and CSF immunoglobulin A (IgA) levels were significantly higher than in AQP4-IgG-positive NMOSD patients (p = 0.038, p = 0.039, p = 0.021, respectively). The ROC curves showed that SIRI had a sensitivity of 0.68 and a specificity of 0.7 for distinguishing MOGAD from AQP4-IgG-positive NMOSD, with an AUC of 0.692 (95% CI: 0.567-0.818, p = 0.0054). Additionally, compared to HCs, both MOGAD and AQP4-IgG-positive NMOSD patients had higher neutrophils, neutrophil-to-lymphocyte ratio (NLR), SIRI, and systemic immune-inflammation index (SII). Eight (32%) of the 25 MOGAD patients had recurrence within 12 months. We found that the monocyte-to-lymphocyte ratio (MLR, AUC = 0.805, 95% CI = 0.616-0.994, cut-off value = 0.200, sensitivity = 0.750, specificity = 0.882) was an effective predictor of MOGAD recurrence. Binary logistic regression analysis showed that MLR below 0.200 at first admission was the only risk factor for recurrence (p = 0.005, odds ratio =22.5, 95% CI: 2.552-198.376).
CONCLUSION
Elevated SIRI aids in distinguishing MOGAD from AQP4-IgG-positive NMOSD; lower MLR levels may be linked to the risk of MOGAD recurrence.
目的
鉴定可靠的免疫炎症指标，以区分髓鞘少突胶质细胞糖蛋白抗体相关性疾病（MOGAD）与抗水通道蛋白 4 免疫球蛋白 G（AQP4-IgG）阳性视神经脊髓炎谱系疾病（NMOSD）。评估这些指标在 MOGAD 复发中的预测意义。
方法
本研究纳入了 25 例 MOGAD 患者、60 例 AQP4-IgG 阳性 NMOSD 患者和 60 例健康对照者（HCs）。这三组患者的年龄和性别相匹配。记录了参与者的临床和影像学表现、扩展残疾状况量表（EDSS）评分、脑脊液（CSF）信息和血细胞计数。随后，计算并比较了 MOGAD、AQP4-IgG 阳性 NMOSD 和 HCs 三组之间的免疫炎症指标。此外，我们采用 ROC 曲线分析评估了每个指标的预测性能，采用二元逻辑回归分析评估了潜在的危险因素。
结果
MOGAD 患者的全身炎症反应指数（SIRI）、CSF 白细胞计数（WCC）和 CSF 免疫球蛋白 A（IgA）水平明显高于 AQP4-IgG 阳性 NMOSD 患者（p=0.038、p=0.039、p=0.021）。ROC 曲线显示，SIRI 区分 MOGAD 与 AQP4-IgG 阳性 NMOSD 的灵敏度为 0.68，特异性为 0.7，AUC 为 0.692（95%CI：0.567-0.818，p=0.0054）。此外，与 HCs 相比，MOGAD 和 AQP4-IgG 阳性 NMOSD 患者的中性粒细胞、中性粒细胞与淋巴细胞比值（NLR）、SIRI 和全身免疫炎症指数（SII）均更高。25 例 MOGAD 患者中有 8 例（32%）在 12 个月内复发。我们发现，单核细胞与淋巴细胞比值（MLR，AUC=0.805，95%CI=0.616-0.994，截断值=0.200，灵敏度=0.750，特异性=0.882）是 MOGAD 复发的有效预测因子。二元逻辑回归分析显示，初次入院时 MLR 低于 0.200 是复发的唯一危险因素（p=0.005，优势比=22.5，95%CI：2.552-198.376）。
结论
升高的 SIRI 有助于区分 MOGAD 与 AQP4-IgG 阳性 NMOSD；较低的 MLR 水平可能与 MOGAD 复发的风险相关。
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