合并症与水通道蛋白4抗体阳性视神经脊髓炎谱系障碍和髓鞘少突胶质细胞糖蛋白抗体相关疾病的不良预后相关：来自CROCTINO队列的探索性研究
Comorbidities Are Associated With Unfavorable Outcome in Aquaporin-4 Antibody Positive Neuromyelitis Optica Spectrum Disorders and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: Exploratory Study From the CROCTINO Cohort.
作者信息
Samadzadeh Sara, Oertel Frederike Cosima, Salih Hadi, Lin Ting-Yi, Motamedi Seyedamirhosein, Chien Claudia, Cook Lawrence J, Lana-Peixoto Marco Aurélio, Fontenelle Mariana Andrade, Kim Ho Jin, Hyun Jae-Won, Jung Su-Kyung, Palace Jaqueline, Roca-Fernandez Adriana, Leite Maria Isabel, Sharma Srilakshmi M, Ashtari Fereshteh, Kafieh Rahele, Dehghani Alireza, Pourazizi Mohsen, Pandit Lekha, Dcunha Anitha, Aktas Orhan, Ringelstein Marius, Albrecht Philipp, May Eugene F, Tongco Caryl, Leocani Letizia, Pisa Marco, Radaelli Marta, Sánchez-Dalmau Bernardo, Martinez-Lapiscina Elena H, Stiebel-Kalish Hadas, Hellmann Mark A, Lotan Itay, Siritho Sasitorn, de Seze Jérôme, Senger Thomas, Havla Joachim, Marignier Romain, Tilikete Caroline Froment, Cobo-Calvo Alvaro, Bichuetti Denis, Tavares Ivan Maynart, Soelberg Kerstin, Altintas Ayse, Yildirim Rengin, Tanriverdi Uygur, Jacob Anu, Huda Saif, Rimler Zoe, Reid Allyson, Mao-Draayer Yang, Villoslada Pablo, de Castillo Ibis Soto, Green Ari, Petzold Axel, Yeaman Michael R, Smith Terry J, Brandt Alexander U, Zimmermann Hanna G, Paul Friedemann, Asgari Nasrin
机构信息
Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
The Center for Neurological Research, Department of Neurology Slagelse Hospitals, Slagelse, Denmark.
出版信息
Eur J Neurol. 2025 Jun;32(6):e70214. doi: 10.1111/ene.70214.
BACKGROUND
Comorbidities occur in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and double seronegative NMOSD (DN-NMOSD), potentially contributing to a less favorable disease course.
OBJECTIVES
To characterize comorbidities in AQP4-NMOSD, MOGAD, and DN-NMOSD and assess their association with optic neuritis (ON) outcomes by optical coherence tomography (OCT) in AQP4-NMOSD.
METHODS
Four hundred and forty-two participants from the CROCTINO cohort were evaluated for comorbidities.
RESULTS
In AQP4-NMOSD patients (n = 360), 43.5% (n = 161) had comorbidities, equally divided between single and multiple. In MOGAD (n = 49), 40.8% had comorbidities, with 75% (n = 15) single and 25% (n = 5) multiple. In DN-NMOSD (n = 33), 36.4% (n = 12) had comorbidities equally split. AQP4-NMOSD patients had more multiple comorbidities (50%, n = 81/161) than MOGAD (25%, n = 5/20, p = 0.03) and more autoimmune disorders (AID) (40.4%, n = 65) than MOGAD (20%, n = 4, p = 0.09) and DN-NMOSD (none, p = 0.004). Cardiovascular comorbidities and related risk factors (CVC/RF) occurred in 34.8% (n = 56) of AQP4-NMOSD, 50% (n = 10) of MOGAD, and 33.3% (n = 4) of DN-NMOSD. Expanded Disability Status Scale was higher in MOGAD (3.0 vs. 2.0, p = 0.006) and DN-NMOSD (5.0 vs. 2.0, p = 0.008) with comorbidities. AQP4-NMOSD patients with CVC/RF had higher ON relapse rates than those with AID (1.06 ± 3.33 vs. 0.49 ± 0.98, p < 0.001). OCT revealed reduced inner nuclear layer thickness in AQP4-NMOSD with comorbidities compared to non-comorbidity (B = -1.52, p = 0.047), more pronounced with CVC/RF (B = -2.96, p = 0.009).
CONCLUSION
Comorbidities are frequent in AQP4-NMOSD and MOGAD and are associated with ON frequency and disability. These findings highlight the need for proactive comorbidity management to improve patient care.
背景
水通道蛋白4抗体阳性视神经脊髓炎谱系障碍（AQP4-NMOSD）、髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）和双血清阴性NMOSD（DN-NMOSD）中常出现合并症，这可能导致疾病进程预后较差。
目的
明确AQP4-NMOSD、MOGAD和DN-NMOSD中的合并症特征，并通过光学相干断层扫描（OCT）评估AQP4-NMOSD中合并症与视神经炎（ON）预后的相关性。
方法
对来自CROCTINO队列的442名参与者的合并症进行了评估。
结果
在AQP4-NMOSD患者（n = 360）中，43.5%（n = 161）有合并症，单发性和多发性合并症各占一半。在MOGAD患者（n = 49）中，40.8%有合并症，其中75%（n = 15）为单发性，25%（n = 5）为多发性。在DN-NMOSD患者（n = 33）中，36.4%（n = 12）有合并症，两者比例相等。AQP4-NMOSD患者的多发性合并症（50%，n = 81/161）比MOGAD患者（25%，n = 5/20，p = 0.03）更多，自身免疫性疾病（AID）（40.4%，n = 65）比MOGAD患者（20%，n = 4，p = 0.09）和DN-NMOSD患者（无，p = 0.004）更多。心血管合并症及相关危险因素（CVC/RF）在34.8%（n = 56）的AQP4-NMOSD患者、50%（n = 10）的MOGAD患者和33.3%（n = 4）的DN-NMOSD患者中出现。有合并症的MOGAD患者（3.0 vs. 2.0，p = 0.006）和DN-NMOSD患者（5.0 vs. 2.0，p = 0.008）的扩展残疾状态量表评分更高。患有CVC/RF的AQP4-NMOSD患者的ON复发率高于患有AID的患者（1.06±3.33 vs. 0.49±0.98，p < 0.001）。OCT显示，与无合并症的AQP4-NMOSD患者相比，有合并症的患者内核层厚度降低（B = -1.52，p = 0.047），CVC/RF患者更明显（B = -2.96，p = 0.009）。
结论
合并症在AQP4-NMOSD和MOGAD中很常见，并且与ON的发作频率和残疾相关。这些发现凸显了积极管理合并症以改善患者护理的必要性。
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