摘要
目的比较以急性脊髓炎为首发表现的视神经脊髓炎谱系疾病(NMOSD)与多发性硬化(MS)患者的临床特征,侧重比较脊髓影像特点。方法收集2017年1月至2020年6月于郑州大学第一附属医院和郑州大学第五附属医院确诊并治疗的83例NMOSD患者(NMOSD组)和34例MS患者(MS组)的临床资料。患者均以急性脊髓炎为首发表现。NMOSD组患者的特异性水通道蛋白4抗体(AQP4-IgG)均为阳性。比较两组一般临床资料、脑脊液(CSF)检测结果、急性期扩展残疾状态量表(EDSS)评分以及脊髓磁共振成像(MRI)平扫与增强特点等。结果与MS组比较,NMOSD组女性占比、EDSS评分和自身免疫性抗体阳性率较高,CSF压力和寡克隆区带阳性率较低(P<0.05)。与MS组比较,NMOSD组联合病变、长节段脊髓受累、广泛损害、亮斑信号的占比较高,病变长度较长,病灶数量较少,多病灶损害、偏心损害、边界清晰的占比较低(P<0.05)。NMOSD组有69例患者在急性期接受增强扫描,MS组有32例患者在急性期接受增强扫描。NMOSD组增强后强化率[81.2%(56/69)]与MS组[75.0%(24/32)]比较,差异无统计学意义(P>0.05)。与MS组比较,NMOSD组斑片状强化和脊膜强化的占比较高,结节状强化占比较低(P<0.05)。结论NMOSD患者多见于女性,多合并自身免疫性抗体阳性。急性期MS与AQP4-IgG阳性的NMOSD患者在脊髓影像学上可表现出一定的差异性。MRI脊髓扫描显示长节段横贯性脊髓损伤、亮斑信号,增强扫描出现斑片状不均匀强化或脊膜强化可能提示NMOSD。
Objective To compare the clinical features of patients with neuromyelitis optica spectrum disorder(NMOSD)and multiple sclerosis(MS)with acute myelitis as the first manifestation,with emphasis on spinal cord imaging features.Methods The clinical data of 83 patients with NMOSD(NMOSD group)and 34 patients with MS(MS group)diagnosed and treated in the First Affiliated Hospital of Zhengzhou University and the Fifth Affiliated Hospital of Zhengzhou University from January 2017 to June 2020 were collected.Acute myelitis was the first manifestation in all patients.Aquaporin-4 immunoglobulin G(AQP4-IgG)of patients in NMOSD group was positive.The general clinical data,test results of cerebrospinal fluid(CSF),acute extended disability status scale(EDSS)score and the characteristics of plain scan and enhancement of magnetic resonance imaging(MRI)of spinal cord were compared between the two groups.Results Compared with MS group,the proportion of women,EDSS score and positive rate of autoimmune antibody in NMOSD group were higher,while the pressure of CSF and positive rate of oligoclonal zone were lower(P<0.05).Compared with MS group,NMOSD group had higher incidences of combined lesion,long segment spinal cord involvement,extensive lesion and bright spotty lesion,longer lesion length,fewer lesions,lower incidences of multiple lesions,eccentric lesion and clear boundary(P<0.05).A total of 69 patients in NMOSD group received enhanced scanning in acute phase,and 32 patients in MS group received enhanced scanning in acute phase.The enhancement rates in MS group and NMOSD group were 75.0%(24/32)and 81.2%(56/69),respectively.There was no statistical difference of the enhancement rate between NMOSD group and MS group(P>0.05).Compared with MS group,the proportions of patchy enhancement and spinal meningeal enhancement in NMOSD group were higher,while the proportion of tuberous enhancement was lower(P<0.05).Conclusion Patients with NMOSD are more common in women,and more patients are accompanied with positive autoimmune antibodies.The patients with MS and AQP4-IgG positive NMOSD in acute stage could show certain differences in spinal imaging.Long-segment transverse spinal cord injury and bright spot signal on MRI spinal cord scan,and patchy inhomogeneous enhancement or spinal meningeal enhancement on enhanced scan might suggest NMOSD.
作者
杜娟
周晨光
李谦
赵凯
卢宏
王建平
DU Juan;ZHOU Chenguang;LI Qian;ZHAO Kai;LU Hong;WANG Jianping(Department of Neouology,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neouology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《河南医学研究》
CAS
2021年第16期2886-2889,共4页
Henan Medical Research
基金
国家自然科学基金面上项目(81771247)。
关键词
视神经脊髓炎谱系疾病
多发性硬化
脊髓炎
急性期
磁共振成像
neuromyelitis optica spectrum disorder
multiple sclerosis
myelitis
acute phase
magnetic resonance imaging
