視神經(jīng)脊髓炎譜系疾病患者視神經(jīng)損害相關(guān)因素分析
發(fā)布時(shí)間：2019-01-09 01:41
【摘要】：研究目的:分析NMOSD患者視神經(jīng)損害的臨床、血液、腦脊液特點(diǎn),探討與NMOSD視神經(jīng)損害發(fā)生相關(guān)的危險(xiǎn)因素及其臨床意義。研究方法:回顧性分析2010年1月-2016年2月在長(zhǎng)海醫(yī)院神經(jīng)內(nèi)科以2015年版國(guó)際共識(shí)及診斷標(biāo)準(zhǔn)納入的108例NMOSD患者,收集患者臨床與生化資料,根據(jù)是否有視神經(jīng)損害分為視神經(jīng)損害組與無視神經(jīng)損害組,并比較兩組患者間的臨床與生化特征;根據(jù)AQP4抗體是否陽(yáng)性將患者分為AQP4抗體陽(yáng)性組與陰性組,并比較兩組間的臨床、生化特點(diǎn),通過Speaman及Pearson相關(guān)分析探究AQP4抗體、血肌酐與NMOSD患者視神經(jīng)損害的相關(guān)性,以此探討NMOSD視神經(jīng)損害的發(fā)病機(jī)制;根據(jù)男女性別分組分析血肌酐與視神經(jīng)損害發(fā)生的相關(guān)性,通過多因素分析血肌酐水平對(duì)視神經(jīng)損害的風(fēng)險(xiǎn)性。研究結(jié)果:本研究納入的108例NMOSD患者中,視神經(jīng)損害組53例,無視神經(jīng)損害55例,兩組之間性別、發(fā)病年齡、病程、外周血白細(xì)胞、谷丙轉(zhuǎn)氨酶、腦脊液蛋白、腦脊液免疫球蛋白及寡克隆帶比較無統(tǒng)計(jì)學(xué)差異(P0.05),復(fù)發(fā)次數(shù)、血肌酐及AQP4抗體比較有統(tǒng)計(jì)學(xué)差異(P0.05)。AQP4抗體陽(yáng)性組50例,陰性組17例,兩組之間視神經(jīng)損害發(fā)生率比較有統(tǒng)計(jì)學(xué)差異(X2=8.267,P0.05)。AQP4抗體與視神經(jīng)損害發(fā)生呈正相關(guān)(r=0.351,P0.05)。視神經(jīng)損害組患者血肌酐中位數(shù)54.00μmol/L,四分位間距15.00μmol/L;無視神經(jīng)損害組血肌酐中位數(shù)61.00μmol/L,四分位間距24.00μmol/L,兩組間血肌酐比較有統(tǒng)計(jì)學(xué)差異(P=0.018),血肌酐水平與視神經(jīng)損害發(fā)生呈負(fù)相關(guān)(r=-0.260,P0.05)。在NMOSD總體人群中視神經(jīng)損害與無損害組血肌酐水平有顯著統(tǒng)計(jì)學(xué)差異,通過分層分析,這種差異性在男性患者中仍然存在(P=0.024)。將男性患者按血肌酐測(cè)值分成漸升高的三等份,三組間視神經(jīng)損害發(fā)生率比較有統(tǒng)計(jì)學(xué)差異(P=0.048)�？紤]到年齡、復(fù)發(fā)次數(shù)、AQP4抗體等因素影響,在男性患者中,分析逐漸升高的三組血肌酐水平對(duì)視神經(jīng)損害的風(fēng)險(xiǎn)比,Q1為基線水平,此時(shí)OR=1.0,隨著SCR值增加,SCR對(duì)視神經(jīng)損害發(fā)生的OR為0.33、0.05,其保護(hù)作用隨之增加。研究結(jié)論:本研究結(jié)果顯示AQP4抗體陽(yáng)性的NMOSD患者易出現(xiàn)視神經(jīng)損害,是其危險(xiǎn)因素,兩者正相關(guān)性有助于NMOSD患者視神經(jīng)損害的早期預(yù)判及病情監(jiān)測(cè)。本研究證實(shí)較高的血肌酐水平可能降低視神經(jīng)損害的發(fā)生率,兩者負(fù)相關(guān)性提示血肌酐可能為NMOSD患者視神經(jīng)損害的保護(hù)性因素,尤其對(duì)男性患者而言,但肯定結(jié)論尚需大樣本前瞻性研究進(jìn)一步證實(shí)。
[Abstract]:Objective: to analyze the clinical, blood and cerebrospinal fluid (CSF) features of optic nerve damage in patients with NMOSD, and to explore the risk factors associated with optic nerve damage in NMOSD and its clinical significance. Methods: the clinical and biochemical data of 108 patients with NMOSD were analyzed retrospectively from January 2010 to February 2016 in the Department of Neurology, Changhai Hospital, according to the international consensus and diagnostic criteria of 2015 edition, and the clinical and biochemical data of the patients were collected. According to whether there was optic nerve damage, the patients were divided into optic nerve injury group and non-optic nerve injury group, and the clinical and biochemical characteristics between the two groups were compared. According to whether the AQP4 antibody is positive or not, the patients were divided into AQP4 antibody positive group and negative group. The clinical and biochemical characteristics of the two groups were compared. The correlation between AQP4 antibody, serum creatinine and optic nerve damage in NMOSD patients was investigated by Speaman and Pearson correlation analysis. To explore the pathogenesis of optic nerve injury in NMOSD. The correlation between serum creatinine and optic nerve injury was analyzed according to the sex groups of men and women. The risk of optic nerve damage was analyzed by multivariate analysis of serum creatinine level. Results: in this study, there were 53 cases of optic nerve injury group and 55 cases of no optic nerve damage. Sex, age, course of disease, peripheral white blood cell, glutamic pyruvate aminotransferase, cerebrospinal fluid protein were all involved in this study. There was no significant difference in CSF immunoglobulin and oligoclonal bands (P0.05), but the recurrence times, serum creatinine and AQP4 antibody were significantly different (P0.05). There were 50 cases of positive AQP4 antibody group, 17 cases of negative group, 50 cases of AQP4 antibody positive group, 17 cases of negative group. The incidence of optic nerve damage was significantly different between the two groups (X2 + 8.267). There was a positive correlation between AQP4 antibody and optic nerve damage (r = 0.351 P 0.05). Median serum creatinine 54.00 渭 mol/L, quartile spacing 15.00 渭 mol/L; in optic nerve lesion group There was a significant difference in serum creatinine between the two groups (P0. 018). There was a negative correlation between serum creatinine level and optic nerve damage (r = 0. 260, P < 0. 260). P0.05). There were significant differences in creatinine levels between the optic nerve injury group and the non-damaged group in the NMOSD population, and the difference was still found in male patients by stratified analysis (P0. 024). The male patients were divided into three equal groups according to the serum creatinine test value. The incidence of optic nerve damage was significantly different among the three groups (P0. 048). Considering the influence of age, relapse times and AQP4 antibody, the risk ratio of serum creatinine level to optic nerve damage was analyzed in male patients. Q1 was the baseline level, and OR=1.0, increased with the increase of SCR value. The OR of SCR on optic nerve injury was 0.33 0. 05, and its protective effect was increased. Conclusion: the results of this study show that NMOSD patients with positive AQP4 antibody are prone to optic nerve damage, which is a risk factor. The positive correlation between the two factors is helpful to early prediction and disease monitoring of optic nerve damage in NMOSD patients. This study confirmed that high serum creatinine levels may reduce the incidence of optic nerve damage. The negative correlation between the two suggests that serum creatinine may be a protective factor for optic nerve damage in NMOSD patients, especially in men. But the positive conclusion needs to be further confirmed by a large sample of prospective studies.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R744.52
本文編號(hào)：2405155
[Abstract]:Objective: to analyze the clinical, blood and cerebrospinal fluid (CSF) features of optic nerve damage in patients with NMOSD, and to explore the risk factors associated with optic nerve damage in NMOSD and its clinical significance. Methods: the clinical and biochemical data of 108 patients with NMOSD were analyzed retrospectively from January 2010 to February 2016 in the Department of Neurology, Changhai Hospital, according to the international consensus and diagnostic criteria of 2015 edition, and the clinical and biochemical data of the patients were collected. According to whether there was optic nerve damage, the patients were divided into optic nerve injury group and non-optic nerve injury group, and the clinical and biochemical characteristics between the two groups were compared. According to whether the AQP4 antibody is positive or not, the patients were divided into AQP4 antibody positive group and negative group. The clinical and biochemical characteristics of the two groups were compared. The correlation between AQP4 antibody, serum creatinine and optic nerve damage in NMOSD patients was investigated by Speaman and Pearson correlation analysis. To explore the pathogenesis of optic nerve injury in NMOSD. The correlation between serum creatinine and optic nerve injury was analyzed according to the sex groups of men and women. The risk of optic nerve damage was analyzed by multivariate analysis of serum creatinine level. Results: in this study, there were 53 cases of optic nerve injury group and 55 cases of no optic nerve damage. Sex, age, course of disease, peripheral white blood cell, glutamic pyruvate aminotransferase, cerebrospinal fluid protein were all involved in this study. There was no significant difference in CSF immunoglobulin and oligoclonal bands (P0.05), but the recurrence times, serum creatinine and AQP4 antibody were significantly different (P0.05). There were 50 cases of positive AQP4 antibody group, 17 cases of negative group, 50 cases of AQP4 antibody positive group, 17 cases of negative group. The incidence of optic nerve damage was significantly different between the two groups (X2 + 8.267). There was a positive correlation between AQP4 antibody and optic nerve damage (r = 0.351 P 0.05). Median serum creatinine 54.00 渭 mol/L, quartile spacing 15.00 渭 mol/L; in optic nerve lesion group There was a significant difference in serum creatinine between the two groups (P0. 018). There was a negative correlation between serum creatinine level and optic nerve damage (r = 0. 260, P < 0. 260). P0.05). There were significant differences in creatinine levels between the optic nerve injury group and the non-damaged group in the NMOSD population, and the difference was still found in male patients by stratified analysis (P0. 024). The male patients were divided into three equal groups according to the serum creatinine test value. The incidence of optic nerve damage was significantly different among the three groups (P0. 048). Considering the influence of age, relapse times and AQP4 antibody, the risk ratio of serum creatinine level to optic nerve damage was analyzed in male patients. Q1 was the baseline level, and OR=1.0, increased with the increase of SCR value. The OR of SCR on optic nerve injury was 0.33 0. 05, and its protective effect was increased. Conclusion: the results of this study show that NMOSD patients with positive AQP4 antibody are prone to optic nerve damage, which is a risk factor. The positive correlation between the two factors is helpful to early prediction and disease monitoring of optic nerve damage in NMOSD patients. This study confirmed that high serum creatinine levels may reduce the incidence of optic nerve damage. The negative correlation between the two suggests that serum creatinine may be a protective factor for optic nerve damage in NMOSD patients, especially in men. But the positive conclusion needs to be further confirmed by a large sample of prospective studies.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R744.52
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