Wang Yanyan, Wang Feng, Huang Teng, Zeng Ziling, Jiao Li, Sun Hao, Zhang Xiaoyu, Wang Baojie, Liu Rujia, Guo Shougang
Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China.
Department of Neurology, Rongcheng People's Hospital Affiliated to Jining Medical University, Weihai, China.
Front Neurosci. 2025 Jul 15;19:1629357. doi: 10.3389/fnins.2025.1629357. eCollection 2025.
Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare inflammatory demyelinating disorder of the central nervous system, frequently resulting in irreversible neurological deficits such as blindness and paralysis. Emerging evidence suggests that dyslipidemia is associated with increased disability and poorer outcomes in autoimmune diseases. The purpose of the study is to investigate the associations between lipid profile with neurological impairment and relapse.
This study retrospectively collected data from 130 hospitalized patients with AQP4-IgG positive NMOSD. Based on the Expanded Disability Status Scale (EDSS) scores at admission, patients were categorized into a mild-to-moderate group (EDSS ≤ 5.5) and a severe group (EDSS ≥ 6). All included patients were followed for at least 1 year, and were further divided into relapse and non-relapse groups based on whether a relapse occurred during the follow-up period. Logistic regression analysis was used to identify independent risk factors associated with the severity of neurological impairment and relapse. Receiver operating characteristic (ROC) curve analysis was conducted to determine the cutoff value of apolipoprotein A-I (ApoA-I) in predicting severe neurological impairment. Spearman correlation analysis was performed to assess the relationships among ApoA-I, high-density lipoprotein cholesterol (HDL-C) and CRP.
Multivariate binary logistic regression analysis revealed that ApoA-I (OR = 0.138, 95% CI: 0.021-0.902, = 0.039) and the number of spinal cord lesion segments (OR = 1.368, 95% CI: 1.181-1.584, < 0.001) were independent risk factors for the severity of neurological impairment. The area under the ROC curve (AUC) for ApoA-I in predicting the severity of neurological impairment was 0.647 (95% CI: 0.542-0.751), with a cutoff value of 1.165, a sensitivity of 59.4%, and a specificity of 67.6%. Multivariate logistic regression analysis identified HDL-C (OR = 0.082, 95% CI: 0.008-0.847, = 0.036), clinical phenotype-specifically, compared to optic neuritis, myelitis (OR = 0.130, 95% CI: 0.037-0.458, = 0.002), brainstem/cerebral syndrome (OR = 0.070, 95% CI: 0.007-0.731, = 0.026), and mixed phenotypes (OR = 0.107, 95% CI: 0.018-0.642, = 0.014) -as well as the use of subsequent monoclonal antibody therapy (OR = 0.190, 95% CI: 0.045-0.799, = 0.023) as independent protective factors against relapse. Spearman correlation analysis showed that ApoA-I and HDL-C were significantly negatively correlated with CRP ( = -0.230, = 0.008; = -0.310, < 0.001, respectively).
Reduced levels of ApoA-I and HDL-C were associated with more severe neurological deficits and an increased risk of relapse.
视神经脊髓炎谱系障碍（NMOSD）是一种罕见的中枢神经系统炎性脱髓鞘疾病，常导致不可逆的神经功能缺损，如失明和瘫痪。新出现的证据表明，血脂异常与自身免疫性疾病中残疾程度增加和预后较差有关。本研究的目的是探讨血脂水平与神经功能损害及复发之间的关联。
本研究回顾性收集了130例住院的水通道蛋白4-IgG阳性NMOSD患者的数据。根据入院时的扩展残疾状态量表（EDSS）评分，将患者分为轻至中度组（EDSS≤5.5）和重度组（EDSS≥6）。所有纳入患者均随访至少1年，并根据随访期间是否复发进一步分为复发组和非复发组。采用逻辑回归分析确定与神经功能损害严重程度和复发相关的独立危险因素。进行受试者工作特征（ROC）曲线分析以确定载脂蛋白A-I（ApoA-I）预测严重神经功能损害的临界值。进行Spearman相关性分析以评估ApoA-I、高密度脂蛋白胆固醇（HDL-C）和CRP之间的关系。
多因素二元逻辑回归分析显示，ApoA-I（OR = 0.138，95%CI：0.021 - 0.902，P = 0.039）和脊髓病变节段数（OR = 1.368，95%CI：1.181 - 1.584，P < 0.001）是神经功能损害严重程度的独立危险因素。ApoA-I预测神经功能损害严重程度的ROC曲线下面积（AUC）为0.647（95%CI：0.542 - 0.751），临界值为1.165，敏感性为59.4%，特异性为67.6%。多因素逻辑回归分析确定HDL-C（OR = 0.082, 95%CI：0.008 - 0.847, P = 0.036）、临床表型 - 具体而言，与视神经炎相比，脊髓炎（OR = 0.130, 95%CI：0.037 - 0.458, P = 0.002）、脑干/大脑综合征（OR = 0.070, 95%CI：0.007 - 0.731, P = 0.026）和混合表型（OR = 0.107, 95%CI：0.018 - 0.642, P = 0.014） - 以及随后使用单克隆抗体治疗（OR = 0.190, 95%CI：0.045 - 0.799, P = 0.023）作为预防复发的独立保护因素。Spearman相关性分析表明，ApoA-I和HDL-C与CRP均呈显著负相关（分别为r = -0.230, P = 0.008；r = -0.310, P < 0.001）。
ApoA-I和HDL-C水平降低与更严重的神经功能缺损及复发风险增加相关。
