摘要
目的评价抗水通道蛋白4抗体（抗AQP4抗体）诊断视神经脊髓炎（NMO）的敏感度与特异度，分析抗体滴度与临床症状、影像学表现及激素治疗的相关性。方法收集2006年12月至2012年10月在首都医科大学宣武医院神经内科就诊的NMO、多发性硬化（MS）、其他神经系统疾病及免疫系统疾病患者的血清，采用细胞免疫荧光检测方法检测血清中的抗AQP4抗体。利用配对资料秩和检验分析激素治疗前后抗体滴度的变化，采用Spearman相关系数分析抗体滴度与临床症状、影像的相关性。结果（1）抗AQP4抗体诊断NMO的敏感度76．6％，特异度97．0％。（2）抗AQP抗体滴度与NMO患者疾病复发次数、脊髓病变长度及EDSS评分未见明显相关性（P〉0．05）。（3）10例发病急性期抗AQP4抗体检测阳性的NMO患者在激素冲击治疗后1个月复查抗体，抗体滴度较前明显下降（P〈0．05）。结论抗AQP4抗体诊断NMO具有较高的特异度和敏感度，激素治疗可能使抗AQP4抗体滴度降低，但抗AQP4抗体滴度与EDSS评分、复发次数及脊髓病变长度无明显相关性。
Objective To assess the sensitivity and specificity of anti-aquaporin 4 antibody in the diagnosis of neuromyelitis optica （NMO） and analyze the relationship between clinical features and different NMO-IgG status. Methods A total of 269 serum specimens were collected from the patients with NMO, high-risk for NMO, multiple sclerosis （MS） and miscellaneous diseases and analyzed with HEK-293T cells transfected by aquaporin 4 eDNA. The sensitivity and specificity of anti-aquaporin 4 antibody in the diagnosis of NMO were calculated, Spearman correlation coefficients were used to examine the relationship between clinical features and antibody titer. Results （ 1 ） The results of cell-based immunofluorescence assay showed 36 examples of 47 NMO patient serums （76.6%） were positive, 7/23 high-risk for NMO positive （30.4%）, 3/85 multiple sclerosis （3.5%） positive, 1/48 miscellaneous neurological disorders （2. 1% ）, 2/16 immune system diseases positive （12. 5% ） and negative in all 50 healthy serum specimens. Sensitivity and specificity were 76.6% and 97.0% for discriminating NMO from MS and other diseases. （2） Anti-AQP4 antibody titer had no obvious correlation to relapses, spinal lesion length and EDSS （P 〉 0. 05 ）. （3） Anti-AQP4 antibody titer became lower after a high dose of intravenous methylpredonisolone （P 〈 0.05 ）. Conclusion Anti-AQP4 antibody in NMO has a high specificity and sensitivity so as to contribute to early diagnosis and optimized treatment of NMO. And its titer decreases after a high dose of intravenous methylpredonisolone. But there is no correlation between its titer and length of spinal cord lesions, relapsing frequency or expanded disability status scale （EDSS） score.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第13期1012-1015,共4页
National Medical Journal of China
