47例单个脊髓炎性脱髓鞘病灶转化的影响因素

doi:10.6040/j.issn.1671-7554.0.2022.0986

摘要/Abstract

摘要： 目的分析47例单个脊髓炎性脱髓鞘病灶患者疾病转化的影响因素。方法采用回顾性研究方法,搜集92例首发影像表现为单个脊髓炎性脱髓鞘病灶的患者,根据随访是否出现向视神经脊髓炎谱系疾病(NMOSD)、多发性硬化(MS)或抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病(MOG-AD)转化分为转化组(n=47)与非转化组(n=45):采用独立样本t检验、χ2检验、Fisher确切概率法或Mann-Whitney U检验比较两组临床资料,二分类Logistic回归分析疾病转化的独立危险因素。结果在47例转化组和45例非转化组中,疾病转化与年龄、随访过程中出现视力障碍、脊髓MRI累及节段≥3个、风湿系列异常、中枢神经系统(CNS)脱髓鞘抗体阳性及复发存在统计学意义(P<0.05)。二分类Logistic回归分析显示复发(OR=6.850,95%CI:2.206~21.270,P=0.001)、MRI累及节段≥3个(OR=3.968,95%CI:1.230~12.805,P=0.021)、CNS脱髓鞘抗体阳性(OR=19.983,95%CI:2.258~176.816,P=0.007)是转化的独立危险因素。结论单个脊髓炎性脱髓鞘病灶的转化与年龄、随访过程中出现视力障碍、MRI长度、CNS脱髓鞘抗体、风湿系列抗体、复发多种因素相关。

关键词: 脱髓鞘, 脊髓炎, 复发, 转化, 磁共振, 水通道蛋白4

Abstract: Objective To analyze the influencing factors of disease transformation in 47 patients with single demyelinating lesion of spinal cord. Methods The clinical data of 92 patients with single demyelinating lesion of spinal cord were retrospectively analyzed. According to the presence of neuromyelitis optica spectrum disorders(NMOSD), multiple sclerosis(MS), and myelin oligodendrocytes glycoprotein associated disorders(MOG-AD)during the follow-up, the patients were divided into transformed group(n=47)and non-transformed group(n=45). Independent-samples t test, χ2 test, Fishers exact test or Mann-Whitney U test were used to compare the clinical data of the two groups. The independent risk factors of disease transformation were analyzed with binary Logistic regression. Results There were significant association between disease transformation and patients age, visual impairment during follow-up, segments of spinal cord ≥3, abnormality of rheumatic series, positive central nervous system demyelinating antibody and recurrence(P<0.05). Binary Logistic regression analysis showed that recurrence(OR=6.850, 95%CI: 2.206-21.270, P=0.001), segments of spinal cord ≥3(OR=3.968, 95%CI: 1.230-12.805, P=0.021), and positive central nervous system demyelinating antibody(OR=19.983, 95%CI: 2.258-176.816, P=0.007)were independent risk factors of disease transformation. Conclusion The transformation of a single demyelinating lesion of spinal cord is associated with age, visual impairment during follow-up, segments of spinal cord ≥3, positive central nervous system demyelinating antibody, abnormality of rheumatism series and recurrence.

Key words: Demyelination, Myelitis, Recurrence, Transformation, Magnetic resonance imaging, Aquaporin-4

中图分类号:

R741

李晴,张安娜,杜艳圣,刁久洲,崔若瑾,付鹏蕊,岳欣毅,周庆博. 47例单个脊髓炎性脱髓鞘病灶转化的影响因素[J]. 山东大学学报 (医学版), 2023, 61(5): 37-43.

LI Qing, ZHANG Anna, DU Yansheng, DIAO Jiuzhou, CUI Ruojin, FU Pengrui, YUE Xinyi, ZHOU Qingbo. Influencing factors of the transformation of single demyelinating lesion of spinal cord in 47 cases[J]. Journal of Shandong University (Health Sciences), 2023, 61(5): 37-43.

参考文献

[1] Hftberger R, Lassmann H. Inflammatory demyelinating diseases of the central nervous system [J]. Handb Clin Neurol, 2018, 145(1): 263-283.
[2] Thulasirajah S, Pohl D, Davila-Acosta J, et al. Myelin oligodendrocyte glycoprotein-associated pediatric central nervous system demyelination: clinical course, neuroimaging findings, and response to therapy [J]. Neuropediatrics, 2016, 47(4): 245-252.
[3] Rintala A, Matcham F, Radaelli M, et al. Emotional outcomes in clinically isolated syndrome and early phase multiple sclerosis: a systematic review and meta-analysis [J]. J Psychosom Res, 2019, 124(9):109761. doi: 10.1016/j.jpsychores.2019.109761.
[4] Valsasina, Paola, Aboulwafa, et al. Cervical cord T1-weighted hypointense lesions at MR imaging in multiple sclerosis: relationship to cord atrophy and disability [J]. Radiology, 2018, 288(1): 234-244.
[5] Bhattacharyya, Shamik. Spinal cord disorders: myelopathy [J]. Am J Med, 2018, 131(11): 1293-1297.
[6] Young V, Quaghebeur G. Transverse myelitis and neuromyelitis optica spectrum disorders [J]. Semin Ultrasound CT MR, 2016, 37(5): 384-395.
[7] Bensi C, Marrodan R, González A, et al. Brain and spinal cord lesion criteria distinguishes AQP4-positive neuromyelitis optica and MOG-positive disease from Multiple Sclerosis [J]. Mult Scler Relat Disord, 2018, 25(2): 246-250.
[8] Hennes EM, Baumann M, Lechner C, et al. MOG spectrum disorders and role of mog-antibodies in clinical practice [J]. Neuropediatrics, 2018, 49(1): 3-11.
[9] MM A, Mah A, Aak A, et al. Differential diagnosis in acute inflammatory myelitis [J]. Mult Scler Relat Disord, 2020,11(46): 102481. doi: 10.1016/j.msard.2020.102481.
[10] Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria [J]. Lancet Neurol, 2018, 17(2): 162-173.
[11] 中华医学会神经病学分会神经免疫学组. 临床孤立综合征的诊断与治疗中国专家共识(2021版)[J]. 中华神经科杂志, 2022, 55(4): 280-289. Chinese Society of Neuroimmunology. Expert consensus on the diagnosis and treatment of clinically isolated syndrome in China [J]. Chinese Journal of Neurology, 2022, 55(4): 280-289.
[12] Wingerchuk D M, Banwell B, Bennett J L, et al. Internationalconsensus diagnostic criteria for neuromyelitis optica spectrum disorders [J]. Neurology, 2015, 85(2): 177-189.
[13] 黄德晖, 吴卫平, 胡学强. 中国视神经脊髓炎谱系疾病诊断与治疗指南(2021版)[J]. 中国神经免疫学和神经病学杂志, 2021, 28(6): 423-436. HUANG Dehui, WU Weiping, HU Xueqiang. Chinese guidelines for diagnosis and treatment of neuromyelitis optica spectrum disorders [J]. Chinese Journal of Neuroimmunology and Neurology, 2021, 28(6): 423-436.
[14] 孙庆利, 马妍, 樊东升. 视神经脊髓炎谱系疾病合并其他自身免疫性疾病临床特点分析[J]. 中国现代神经疾病杂志, 2022, 22(4): 300-305. SUN Qingli, MA Yan, FAN Dongsheng. The clinical characteristics of neuromyelitis optica spectrum disorders with other autoimmune diseases [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2022, 22(4): 300-305.
[15] 中国免疫学会神经免疫分会. 抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病诊断和治疗中国专家共识[J].中国神经免疫学和神经病学杂志, 2020, 27(2): 86-95. Neuroimmunology Group, Chinese Society of Neurology. Expert consensus on the diagnosis and treatment of Myelin Oligodendrocytes Glycoprotein associated disorders in China [J]. Chinese Journal of Neuroimmunology and Neurology, 2020, 27(2): 86-95.
[16] Petzold A, Fraser CL, Abegg M, et al. Diagnosis and classification of optic neuritis [J]. Lancet Neurol, 2022, 21(12): 1120-1134.
[17] Filippi M, Rocca MA, Ciccarelli O, et al. MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines [J]. Lancet Neurol, 2016, 15(3): 292-303.
[18] Dostal M, Kerkovsky M, Stulik J, et al. MR diffusion properties of cervical spinal cord as a predictor of progression to multiple sclerosis in patients with clinically isolated syndrome [J]. J Neuroimaging, 2021,31(1): 108-114.
[19] Eichinger P, Kirschke JS, Hoshi MM, et al. Pre- and postcontrast 3D double inversion recovery sequence in multiple sclerosis: a simple and effective MR imaging protocol [J]. AJNR Am J Neuroradiol, 2017, 38(10): 1941-1945.
[20] Valsasina P, Aboulwafa M, Preziosa P, et al. Cervical cord T1-weighted hypointense lesions at MR imaging in multiple sclerosis: relationship to cord atrophy and disability [J]. Radiology, 2018, 288(1): 234-244.
[21] Chee CG, Park KS, Lee JW, et al. MRI features of aquaporin-4 antibody-positive longitudinally extensive transverse myelitis: insights into the diagnosis of neuromyelitis optica spectrum disorders [J]. AJNR Am J Neuroradiol, 2018, 39(4): 782-787.
[22] Dutra BG, da Rocha AJ, Nunes RH, et al. Neuromyelitis optica spectrum disorders: spectrum of MR imaging findings and their differential diagnosis [J]. Radiographics, 2018, 38(1): 169-193.
[23] Chen C, Liu C, Fang L, et al. Different magnetic resonance imaging features between MOG antibody- and AQP4 antibody-mediated disease: a Chinese cohort study [J]. J Neurol Sci, 2019, 405(10): 116430. doi: 10.1016/j.jns.2019.116430.
[24] Bensi C, Ma R, A González, et al. Brain and spinal cord lesion criteria distinguishes AQP4-positive neuromyelitis optica and MOG-positive disease from Multiple Sclerosis [J]. Mult Scler Relat Disord, 2018, 25(2): 246-250.
[25] Dubey D, Pittock SJ, Krecke KN, et al. Clinical, radiologic, and prognostic features of myelitis associated with myelin oligodendrocyte glycoprotein autoantibody [J]. JAMA Neurol, 2019, 76(3): 301-309.
[26] Bachhuber A. Inflammatory spinal cord diseases and transverse myelitis [J]. Radiologe, 2021, 61(3): 251-257.
[27] Wolska-Krawczyk M. Akute disseminierte Enzephalomyelitis(Acute disseminated encephalomyelitis)[J]. Radiologe, 2022, 62(4): 316-321.
[28] Kolcava J, Kocica J, Hulova M, et al. Conversion of clinically isolated syndrome to multiple sclerosis: a prospective study [J]. Mult Scler Relat Disord, 2020, 44(9): 102262. doi: 10.1016/j.msard.2020.102262.
[29] Ben Noon G, Vigiser I, Shiner T, et al. Reinforcing the evidence of oligoclonal bands as a prognostic factor in patients with Multiple sclerosis [J]. Mult Scler Relat Disord, 2021, 56(11): 103220. doi: 10.1016/j.msard.2021.103220.
[30] Chen B, Gui MC, Ji SQ, et al. Distinct immunological features of inflammatory demyelinating diseases of the central nervous system [J]. Neuroimmunomodulation, 2022, 29(3): 220-230.

相关文章 15

[1]	张莹王宏伟王慧陈福琴. Graves病复发患者外周血中转化生长因子β1水平的变化[J]. 山东大学学报(医学版), 2209, 47(6): 80-.
[2]	王韶卿刘毅慧付婷婷成金勇刘强. 肝癌³¹磷磁共振波谱数据的分类[J]. 山东大学学报(医学版), 2209, 47(6): 42-46.
[3]	张嘉颖,宿荣允,王英惠,王洪刚,柳刚. ACE2基因通过调控Nrf2/HO-1通路改善肾缺血再灌注损伤[J]. 山东大学学报 (医学版), 2023, 61(4): 1-9.
[4]	王磊,张帅,刘钢,由胜男,王植,朱珊,陈超,马信龙,杨强. MRI诊断140例腰椎智能网络自动检测分型MCs方法的比较[J]. 山东大学学报 (医学版), 2023, 61(3): 71-79.
[5]	杨咏青,赵鹏,汪玉,马文静,田迷迷,程亚旎,祖璐,林祥涛. 细胞外容积分数对62例不同病理类型肺癌的诊断价值[J]. 山东大学学报 (医学版), 2023, 61(2): 88-94.
[6]	张忆朦,孙巧玲,杨向东. 过敏性紫癜合并视神经脊髓炎谱系疾病1例[J]. 山东大学学报 (医学版), 2023, 61(2): 137-140.
[7]	侯少瑾,王云凤,曹丽丽,刘学伍,赵秀鹤,王胜军. 视神经脊髓炎谱系疾病53例与多发性硬化11例的脑脊液检测比较[J]. 山东大学学报 (医学版), 2023, 61(1): 32-37.
[8]	赵恩举,赵硕,郭云亮,王锡明. 282例颈动脉钙化与脑小血管病MRI总负荷评分的关联性[J]. 山东大学学报 (医学版), 2023, 61(1): 38-44.
[9]	张秉芬,周胜红,王哲. 延龄草皂苷通过抑制TGF-β/Smad3与Wnt/β-catenin信号通路改善大鼠肺纤维化[J]. 山东大学学报 (医学版), 2022, 60(8): 23-29.
[10]	陶国伟,王芳,董向毅,徐亚瑄,赵琳丽,胡蓓蓓. 子宫腺肌病的超声与MRI诊断及进展[J]. 山东大学学报 (医学版), 2022, 60(7): 56-65.
[11]	孙浩瑜,姜鑫,陈守臻,曲思凤,史本康. 多参数磁共振联合前列腺健康指数对PSA灰区临床有意义前列腺癌的诊断价值[J]. 山东大学学报 (医学版), 2022, 60(6): 46-50.
[12]	申晓畅,孙一卿,颜磊,赵兴波. 芳基烃受体核转位因子样蛋白2在子宫内膜癌中的表达[J]. 山东大学学报 (医学版), 2022, 60(5): 74-80.
[13]	陈兆波,方敏,薛浩然,刘春艳. 去泛素化酶USP35促进非小细胞肺癌细胞迁移和侵袭[J]. 山东大学学报 (医学版), 2022, 60(4): 30-37.
[14]	李鸿皓,于晶,陈亚丽,郭守刚. 20例NMOSD患者CD4⁺CD25⁺FoxP3⁺调节性T细胞数量和FoxP3 mRNA的表达水平[J]. 山东大学学报 (医学版), 2022, 60(4): 50-54.
[15]	冯宝民,王舟,徐晗,李佳存,于乔文,修建军. 抗髓鞘少突胶质细胞糖蛋白IgG抗体相关疾病临床及影像特征[J]. 山东大学学报 (医学版), 2022, 60(3): 45-50.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed