摘要
目的 探讨临床孤立综合征（CIS）转归为多发性硬化（MS）和视神经脊髓炎（NMO）的现状,并分析其影响因素.方法 收集2009年1月至2014年12月海军总医院神经内科住院的CIS患者151例,根据患者首发症状分为脊髓组、视神经组、脑干组及多部位组,并对各组临床转归及扩展残疾功能状态量表（EDSS）评分、血清水通道蛋白4抗体（AQP4-Ab）、脑脊液寡克隆区带（CSF-OB）、诱发电位以及MRI等进行回顾分析.结果 （1）随访时间为（44.11 ±17.62）个月,转归为NMO28例（18.5％）、转归为MS 46例（30.5％）,保持CIS状态66例（43.7％）,诊断单时相横贯性脊髓炎3例、视神经炎4例、同心圆硬化3例、急性播散性脑脊髓炎l例.（2）NMO转归者初次发病时EDSS评分高于MS转归者[（3.93±1.18）分比（3.08±1.15）分,P=0.003].首发症状累及视神经者主要转归为NMO（P=0.000）,首发累及多部位者主要转归为MS（P=0.000）.脑干听觉诱发电位（BAEP）、视觉诱发电位（VEP）、体感诱发电位（SEP）异常率在MS及NMO转归组间差异均无统计学意义（P =0.703;P =0.076;P =0.915）,联合2种（P=0.546）或3种诱发电位（P=1.000）异常率亦无统计学意义.CSF-OB阳性者主要转归为MS（P=0.001）,血清AQP4-Ab阳性者主要转归为NMO（P=0.001）;NMO转归组血清AQP4-Ab阳性率明显高于MS转归组[70.6％（12/17）比8.3％（2/24）,P=0.000].脊髓病灶≥3个椎体节段者NMO转归率显著高于MS（P=0.000）.（3）首发部位累及多部位（OR=4.775,P=0.002）、CSF-OB阳性（OR=7.794,P=0.002）、VEP异常（OR=7.251,P=0.001）是CIS转归为MS的危险因素.女性（OR=12.536,P=0.019）、首发部位累及视神经（OR=14.523,P=0.013）、脊髓病灶≥3个椎体节段（OR=93.602,P=0.001）、AQP4-Ab阳性（OR=36.410,P=0.002）、VEP（OR=18.448,P=0.002）及SEP异常（OR=12.731,P=0.016）是CIS转归为NMO的危险因素.结论 CSF-OB阳性、首发部位累及多部位�
Objective To analyze the features of patients who converted from clinically isolated syndrome （CIS） to multiple sclerosis （MS） and neuromyelitis optica （NMO） and explore the correlated factors.Methods A total of 151 patients admitted in our unit as CIS from January 2009 to December 2014 were enrolled in the study.All patients were divided into the following four groups by locations of the initial lesion,which were the spinal cord,the optic nerve,the brain stem and the multifocal lesions.Data were collected at the baseline including demographics,expanded disability status scale （EDSS） score,site of CIS,presence or absence of cerebrospinal fluid （CSF） oligoclonal bands （OB） and serum aquaporin-4 antibody （AQP4-Ab）,evoked potential （EP） and MRI lesions.The conversion rates from CIS to clinically definite MS or NMO were calculated and the correlated factors were explored.Results With a mean followup period of （44.11 ± 17.62） months,46/151 （30.5%） patients converted to MS,28/151 （18.5%） to definite NMO and 66/151 patients（43.7%） remained as CIS.Other patients were converted to optic neuritis （4/151）,one-time transverse myelitis（3/151）,acute disseminated encephalomyelitis （1/151） and Balo concentric sclerosis（3/151）.The EDSS score was significantly higher in patients converted to NMO than those converted to MS （P =0.003）.The initial manifestation of optic neuritis significantly correlated with the conversion to NMO （P =0.000）,while the initial manifestation of CIS with multifoeal lesions significantly correlated with the conversion to MS （P =0.000）.Neither the isolated BAEP （P =0.703）,VEP （P =0.076）,SEP （P =0.915） nor the combination of two （P =0.546） or three （P =1.000） of the above parameters could help to distinguish the conversion to MS or NMO.More patients with positive CSF-OB converted to MS （P =0.001）,while more patients with positive serum AQP4-Ab converted to NMO （P =0.001）.More patients were serum AQP4-Ab
出处
《中华内科杂志》
CAS
CSCD
北大核心
2016年第6期460-465,共6页
Chinese Journal of Internal Medicine
关键词
临床孤立综合征
多发性硬化
视神经脊髓炎
预后
Clinically isolated syndrome
Multiple sclerosis
Neuromyelitis optica
Prognosis
