發(fā)布時間：2019-01-29 20:35

【摘要】：目的探討視神經(jīng)脊髓炎譜系疾病(NMOSD)合并系統(tǒng)性自身免疫性疾病(SADs)的臨床、影像特點。方法分析2012年～2016年于浙江大學醫(yī)學院附屬第二醫(yī)院神經(jīng)內(nèi)科住院的符合2015年NMOSD診斷標準的81例患者的臨床、影像等資料,并將81例患者按照是否伴有系統(tǒng)性自身免疫性疾病(SADs)分為兩組,對比兩組患者之間的臨床、影像等特點。結(jié)果81例NMOSD患者中,伴有SADs患者19例(23.5%),不伴SADs患者62例(76.5%).81例患者全部送檢抗AQP4抗體,其中77例(95.1%)抗AQP4抗體陽性。血清中抗AQP4抗體陽性率高于腦脊液(p0.05),血清中抗體滴度同樣比腦脊液中更高(p0.05)。15例送檢MOG抗體,其中2例(13.3%)陽性。伴SADs亞組患者血清甲狀腺球蛋白抗體、抗核抗體等自身免疫抗體陽性率顯著高于不伴SADs亞組。伴SADs亞組的14例存在脊髓病變的患者中未發(fā)現(xiàn)延髓頸髓病變相連者(0%),低于不伴SADs亞組(24.5%),差異具有統(tǒng)計學意義(p=0.039)。伴SADs亞組患者脊髓磁共振矢狀位上病變受累長度(以對應(yīng)椎體節(jié)數(shù)計)為5.64±2.73,不伴SADs亞組患者受累長度為4.13±2.21,差異具有統(tǒng)計學意義(p=0.040)。兩組患者在發(fā)病年齡、性別比、臨床表現(xiàn)方面未見明顯差別(p0.05)。兩組患者在頭顱磁共振病灶分布、病灶強化情況,脊髓磁共振受累部位、橫貫性脊髓炎比例、長節(jié)段脊髓炎比例、病灶強化情況等方面同樣未見顯著性差別(p0.05)。結(jié)論伴SADs的NMOSD患者與不伴SADs的NMOSD患者在發(fā)病年齡、性別比、臨床表現(xiàn)、頭顱磁共振表現(xiàn)方面無明顯差別,伴SADs的NMOSD患者脊髓病變節(jié)段較長,較少出現(xiàn)頸髓延髓相連病灶。當NMOSD患者伴有自身免疫抗體陽性、磁共振脊髓病變節(jié)段較長時,需要警惕NMOSD伴有SADs的可能性。
[Abstract]:Objective to investigate the clinical and imaging features of (NMOSD) with systemic autoimmune disease (SADs). Methods the clinical and imaging data of 81 patients admitted to the Department of Neurology of the second affiliated Hospital of Zhejiang University Medical College from 2012 to 2016 who were in accordance with the 2015 NMOSD diagnostic criteria were analyzed. 81 patients were divided into two groups according to whether or not with systemic autoimmune disease (SADs). The clinical and imaging features of the two groups were compared. Results among 81 cases of NMOSD, 19 cases (23.5%) were accompanied with SADs, 62 cases (76.5%) were without SADs. All 81 cases were tested for anti-AQP4 antibody, of which 77 cases (95.1%) were positive for anti-AQP4 antibody. The positive rate of anti AQP4 antibody in serum was higher than that in cerebrospinal fluid (p 0. 05), and the titer of anti AQP4 antibody in serum was also higher than that in cerebrospinal fluid (p 0. 05). Among them, 2 cases (13. 3%) were positive for MOG antibody. The positive rates of serum thyroglobulin antibodies and antinuclear antibodies in patients with SADs subgroup were significantly higher than those in patients without SADs subgroup. In 14 patients with spinal cord disease with SADs subgroup, there was no contiguous medullary cervical spinal cord lesion (0%), which was significantly lower than that without SADs subgroup (24. 5%) (p0. 039). The length of involvement in sagittal position of spinal cord in patients with SADs subgroup was 5.64 鹵2.73 (corresponding to the number of vertebral body segments), and that in patients without SADs subgroup was 4.13 鹵2.21, the difference was statistically significant (p0. 040). There was no significant difference in age, sex ratio and clinical manifestation between the two groups (p 0.05). There was also no significant difference between the two groups in the distribution of cranial MRI lesions, enhancement of lesions, the location of MRI involvement, the proportion of transverse myelitis, the proportion of long segment myelitis, and the enhancement of lesions (p0.05). Conclusion there is no significant difference in age, sex ratio, clinical manifestation and cranial magnetic resonance imaging between NMOSD patients with SADs and NMOSD patients without SADs. NMOSD patients with SADs have longer segments of spinal cord lesions and fewer cervical medulla oblongata lesions. When NMOSD patients are associated with autoimmune antibodies and long segments of MRI spinal cord lesions, the possibility of NMOSD with SADs should be warned.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R744.52;R593.2
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本文編號：2417840