视神经脊髓炎谱系病的危险因素与复发特点临床分析

刘楚楚; 黄洁; 刘雨辉; 周华东; 许力

doi:10.16766/j.cnki.issn.1674-4152.001899

视神经脊髓炎谱系病的危险因素与复发特点临床分析

doi: 10.16766/j.cnki.issn.1674-4152.001899

刘楚楚¹,
黄洁¹,
刘雨辉²,
周华东^{1, 2},
许力^1, ,

1.
蚌埠医学院第一附属医院神经内科，安徽蚌埠 233004
2.
陆军特色医学中心神经内科，重庆 400042

基金项目:

国家自然科学基金 81771177

重庆市基础研究与前沿探索项目 cstc2018jcyjAX0511

详细信息

通讯作者:
许力，E-mail: xuli7292@163.com

中图分类号: R744.3
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- 被引次数: 0
出版历程
- 收稿日期: 2020-11-30
- 网络出版日期: 2022-02-16

Risk factors and recurrence characteristics of neuromyelitis optica spectrum disease

LIU Chu-chu¹,
HUANG Jie¹,
LIU Yu-hui²,
ZHOU Hua-dong^{1, 2},
XU Li^{1
, ,}

1.
Department of Neurology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的通过对视神经脊髓炎谱系疾病(NMOSD)的病例研究，探讨NMOSD的危险因素和复发特点。方法纳入2016年1月—2017年8月在蚌埠医学院第一附属医院神经内科和重庆陆军特色医学中心神经内科确诊的204例NMOSD患者，男性54例，女性150例，平均年龄37.5岁。对照组818例, 与NMOSD组年龄相匹配。收集患者一般临床资料和血清AQP4-IgG水平，并对相关因素进行分析。结果多因素分析发现女性、劳累史、既往合并其他自身免疫性疾病的患者发生风险增加2倍以上(OR=2.473，95% CI: 1.714~3.486；OR=2.319，95% CI: 1.573~3.349；OR=2.210，95% CI: 1.001~4.740)，低经济收入水平者、有上呼吸道感染史、妇科手术/产科手术史、饮酒史和创伤手术史的研究对象发生NMOSD风险增加1.5倍以上(OR=1.502，95% CI: 1.020~2.121；OR=1.651，95% CI: 1.121~2.382；OR=1.712，95% CI: 1.060~3.375；OR=1.830，95% CI: 1.011~3.184；OR=1.928，95% CI: 1.032~3.516)。结论经济收入水平、劳累史、上呼吸道感染史、妇科手术/产科手术、创伤手术史、饮酒史和既往合并其他自身免疫性疾病在一定程度上可能是NMOSD发生的危险因素，NMOSD患者复发可能会导致更严重的临床症状、影像学表现及更差的预后。
- 视神经脊髓炎谱系病 /
- 危险因素 /
- 复发
Abstract: Objective To investigate the risk factors and recurrence characteristics of neuromyelitis optica spectrum disease (NMOSD) through a case study. Methods Total 204 NMOSD patients diagnosed in the Department of Neurology of the First Affiliated Hospital of Bengbu Medical College and the Department of Neurology of Chongqing Army Characteristic Medical Center were included from January 2016 to August 2017. There were 54 males and 150 females, with an average age of 37.5 years. There were 818 cases in the control group, which matched the age of the NMOSD group. Patients' general clinical data and serum AQP4-IgG levels were collected, and related factors were analysed. Results Multivariate analysis found that women with a history of exertion and patients with previous autoimmune diseases increased the risk more than 2 times (OR=2.473, 95% CI: 1.714-3.486; OR=2.319, 95% CI: 1.573-3.349; OR=2.210, 95% CI: 1.001-4.740). For people with low income level, history of upper respiratory tract infection, history of gynaecological surgery/obstetric surgery, alcohol consumption, the risk of patients with history and trauma surgery increased by more than 1.5 times (OR=1.502, 95% CI: 1.020-2.121; OR=1.651, 95% CI: 1.121-2.382; OR=1.712, 95% CI: 1.060-3.375; OR=1.830, 95% CI: 1.011-3.184; OR=1.928, 95% CI: 1.032-3.516). Conclusion Economic income level, history of fatigue, history of upper respiratory tract infection, history of gynaecological surgery/obstetric surgery, history of trauma surgery, history of drinking and other autoimmune diseases may be risk factors for NMOSD to a certain extent. Recurrence of NMOSD patients may lead to more severe clinical symptoms, imaging findings and worse prognosis.
- Neuromyelitis optica spectrum disease /
- Risk factors /
- Relapse

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表 1 NMOSD患者危险因素的单因素分析[例(%)]

组别	例数	性别			年龄(岁)			经济收入水平		劳累史
组别	例数	男性	女性		≥40	＜40		中高经济水平	低	劳累史
正常对照组	818	359(43.9)	459(56.1)		342(41.8)	476(58.2)		667(81.5)	151(18.5)	104(12.7)
NMOSD组	204	54(26.5)	150(73.5)		89(43.6)	115(56.4)		153(75.0)	51(25.0)	37(18.1)
χ²值		20.569			0.221			4.404		4.038
P值		＜0.001			0.638			0.036		0.044

组别	例数		上呼吸道感染史	妇科手术/产科手术	创伤手术史	饮酒史	吸烟史		既往合并其他自身免疫性疾病
正常对照组	818		138(16.9)	22(2.7)	35(4.3)	42(5.1)	43(5.3)		19(2.3)
NMOSD组	204		47(23.0)	12(5.9)	16(7.8)	18(8.8)	14(6.8)		10(4.9)
χ²值			4.191	5.176	4.375	4.021	0.800		3.940
P值			0.041	0.023	0.036	0.045	0.371		0.047
注：劳累史为每天工作或玩耍10 h以上，每月24 d以上(包括工厂工人、送外卖人员、大学生、打麻将、玩手机者)。妇科手术指子宫或卵巢切除；产科手术指早期妊娠终止妊娠手术或剖宫产。经济收入水平为中高经济水平(≥3 000元/月)，低经济水平(＜3 000元/月)。

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表 2 NMOSD患者危险因素的多因素分析

变量	B	SE	Wald χ²	P值	OR值	95% CI
女性	0.915	0.293	6.619	＜0.001	2.473	1.714~3.486
低经济收入水平	0.648	0.397	5.145	0.036	1.502	1.020~2.121
劳累史	0.739	0.462	6.561	0.044	2.319	1.573~3.349
上呼吸道感染史	0.825	0.316	4.258	0.041	1.651	1.121~2.382
妇科手术/产科手术	0.874	0.498	5.357	0.023	1.712	1.060~3.375
创伤手术史	0.616	0.547	6.923	0.036	1.928	1.032~3.516
饮酒史	0.632	0.259	4.127	0.045	1.830	1.011~3.184
合并自身免疫疾病史	0.713	0.317	6.123	0.047	2.210	1.001~4.740
注：因变量为是否患NMOSD，否=0，是=1；自变量中性别，男性=0，女性=1；低经济水平，否=0，是=1；劳累史，否=0，是=1；上呼吸道感染史，否=0，是=1；妇科手术/产科手术，否=0，是=1；创伤手术史，否=0，是=1；饮酒史，否=0，是=1；合并自身免疫疾病史，否=0，是=1。

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表 3 NMOSD患者的临床特点[例(%)]

组别	例数	首发症状		视神经受累		视神经损伤程度		脊髓损伤症状			脑干损伤症状
组别	例数	以视神经炎起病	以急性脊髓炎起病	视神经单侧受累	视神经双侧受累	视力下降	失明	双下肢瘫痪	感觉障碍	尿潴留	眼晕/眼球震颤/呕吐	饮水呛咳/吞咽困难
NMOSD初发组	117	60(51.3)	57(48.7)	56(47.9)	61(52.1)	90(76.9)	27(23.1)	15(12.8)	48(41.0)	5(4.3)	9(7.7)	2(1.7)
NMOSD复发组	87	57(65.5)	30(34.5)	29(33.3)	58(66.7)	53(60.9)	34(39.1)	21(24.1)	50(57.5)	5(5.7)	15(17.2)	7(8.0)
^χ²值		4.134		4.334		6.098		4.398	5.406	0.232	4.383	4.751
P值		0.042		0.037		0.014		0.036	0.020	0.629	0.036	0.029

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表 4 NMOSD患者的血清学、电生理和影像学特点[例(%)]

组别	例数	AQP4-IgG(+)	脑脊液		视觉诱发电位P100显著延长	影像学MRI
组别	例数	AQP4-IgG(+)	白细胞>50×10⁶/L	蛋白>1 g/L	视觉诱发电位P100显著延长	视神经肿胀增粗	脊髓受累病灶＞6段	脑内脱髓鞘病灶
NMOSD初发组	117	72(61.5)	58(49.6)	27(23.1)	44(37.6)	42(35.9)	33(28.2)	8(6.8)
NMOSD复发组	87	65(74.7)	55(63.2)	32(36.8)	46(52.9)	54(62.1)	50(57.5)	14(16.1)
χ²值		3.926	4.237	4.559	4.717	13.718	16.423	4.442
P值		0.048	0.040	0.033	0.029	＜0.001	＜0.001	0.035
注：MRI脑内脱髓鞘病灶多位于皮质下、下丘脑、丘脑、三脑室周围、四脑室周围、大脑脚等部位，这些病灶不符合多发性硬化的影像学诊断学标准。

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表 5 NMOSD患者的预后比较[例(%)]

组别	例数	生活自理	轮椅使用	全盲	死亡
NMOSD初发组	117	80(68.4)	14(12.0)	0(0.0)	0(0.0)
NMOSD复发组	87	47(54.0)	22(25.3)	4(4.6)	3(3.4)
χ²值		4.375	6.093
P值		0.036	0.014	0.032^a	0.076^a
注：生活自理ADL评分>60分。^a为采用Fisher精确检验。

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