CAJ | 학술논문

目的探讨血清抗核抗体谱(ANAs)阳性的视神经脊髓炎(NMO)患者的临床和脑、脊髓磁共振成像特征.方法将2006-2011年首都医科大学宣武医院收治的34例视神经脊髓炎,分为抗核抗体谱阳性组(14例)和抗核抗体谱阴性组(20例),回顾性分析两组NMO患者的临床资料[包括首次发作的残疾状态扩展评分(EDSS)、首次缓解期持续时间、第一年复发阳性率等],总结脑、脊髓磁共振成像特征.结果 (1) NMO抗核抗体谱阳性组和阴性组首次发作EDSS评分分别为(2.8±1.1)分、(2.3±0.8)分,首次缓解期持续时间分别为(9±9)个月、(31±39)个月,第一年复发阳性比例分别为10/14、6/20,两组之间差异有统计学意义(P＜0.05).(2) NMO抗核抗体谱阳性组的磁共振脑损害阳性率为5/14,高于抗核抗体谱阴性组(5/20),但二者之间差异无统计学意义;抗核抗体谱阳性组颈段脊髓单独受累多于胸段脊髓(分别为6/14、1/14),抗核抗体谱阴性组胸段脊髓单独受累多于颈髓(分别为6/20、4/20).结论抗核抗体谱阳性的NMO患者临床首次发作神经功能损伤严重,缓解期短,第一年内疾病易复发,易出现脑损害及颈段脊髓损害.
목적 탐토혈청항핵항체보(ANAs)양성적시신경척수염(NMO)환자적림상화뇌、척수자공진성상특정.방법 장2006-2011년수도의과대학선무의원수치적34례시신경척수염,분위항핵항체보양성조(14례)화항핵항체보음성조(20례),회고성분석량조NMO환자적림상자료[포괄수차발작적잔질상태확전평분(EDSS)、수차완해기지속시간、제일년복발양성솔등],총결뇌、척수자공진성상특정.결과 (1) NMO항핵항체보양성조화음성조수차발작EDSS평분분별위(2.8±1.1)분、(2.3±0.8)분,수차완해기지속시간분별위(9±9)개월、(31±39)개월,제일년복발양성비례분별위10/14、6/20,량조지간차이유통계학의의(P＜0.05).(2) NMO항핵항체보양성조적자공진뇌손해양성솔위5/14,고우항핵항체보음성조(5/20),단이자지간차이무통계학의의;항핵항체보양성조경단척수단독수루다우흉단척수(분별위6/14、1/14),항핵항체보음성조흉단척수단독수루다우경수(분별위6/20、4/20).결론 항핵항체보양성적NMO환자림상수차발작신경공능손상엄중,완해기단,제일년내질병역복발,역출현뇌손해급경단척수손해.
Objective To analyze the clinical features and brain,spinal cord magnetic resonance imaging (MRI) features of neuromyelitis optica(NMO) patients with positive anti-nuclear antibody serum (ANAs).Methods The clinical data of expanded disability status scale (EDSS) score,duration of the first relieving phase and first year recurrence-positive rate and MRI features of 34 NMO patients at our hospital during the period of 2006-2011 were retrospectively reviewed and divided into two groups according to the outcome of antibodies test:ANAs positive group (n =14) and ANAs negative group (n =20).Results (1)In the ANAs-positive group,the EDSS score of first NMO attack was (2.8 ± 1.1 ),first remission continued to (9±9)months and the first year recurrence-positive rate was 71.0％ ; in the ANAs-negative group,the EDSS score of first NMO attack was 2.3 ± 0.8,first remission continued to (31 ± 39) months and the first year recurrence-positive rate was 30.0％.The differences in the first attack EDSS score,duration of first remission and first recurrence rate between two groups were statistically significant ( P ＜ 0.05 ).(2) Brain damage-positive rate in the ANAs-positive group on prompt MRI was 35.71％ (5/14) and it was higher than that in ANAs-negative group (5/20).But no significant difference existed between two groups.The spinal cord lesions were predominantly located in cervical and thoracic spinal cords simultaneously in both groups (about 50％ respectively).And,in the ANAs-positive group,the cervical lesions involved were much more common than the thoracic counterparts (6/14 vs 1/14).However,in the ANAs-negative group,thoracic segments were usually involved (6/20 vs 4/20).Conclusion With severe neurological deficits in the first clinical attack and a short remission,ANAs-positive NMO patients are more prone to relapse in the first year,brain damage and cervical cord injury.