| Objective: To compare the short-term clinical outcomes and safety of patients treated with intravenous high-dose methylprednisolone(IVMP),IVMP plus intravenous immunoglobulin(IVIG)and IVMP plus plasma exchange(PLEX)in acute phase of neuromyelitis optica spectrum disorder(NMOSD).To investigate related factors for short-term outcomes of immunotherapy,including IVMP and IVIG,in the acute phase of NMOSD.Method: We retrospectively analyzed 94 NMOSD patients in acute phase of NMOSD from Jan 2013 to Dec 2019 in Renji Hospital,including66 patients treated with IVMP(IVMP group).17 with IVMP plus IVIG(IVMP+IVIG group)and 11 with IVMP plus PLEX(IVMP+PLEX group).Because there are differences in many clinical indicators between the IVMP group and the IVMP + IVIG group,matching was performed between the two groups according to gender,age,and disease severity,and then the effectiveness was compared.Patients who received IVMP and / or combined with IVIG therapy were treated as immunotherapy patients.According to whether the expanded disability status scale(EDSS)score after treatment was improved,they were divided into two groups,response group and non-response group.Spearman or Pearson correlation analysis was used to explore the correlation between length of spinal lesion and serum albumin and clinical outcomes.The related factors were screened using a binary logistic regression model.ROC curve was used to explore the difference of serum albumin in patients with response and non-response to immunotherapy to find the best predictive value.The side effects during treatment were recorded in the three groups,and their safety during hospitalization was compared.Results: 1.The overall treatment response rate was 69.15%(N = 65),the median EDS decreased from 3.75(2.5-7.5)at admission to 3(2.0-6.0)at discharge.The effective rates of IVMP group,IVMP+IVIG group,and IVMP+PLEX group were 72.73%,52.94%,and 72.73%,respectively(p =0.315).The improvement of EDSS in the IVMP + PLEX group was not less than 1.In matched IVMP group and the IVMP+IVIG group,the effective rates of treatment were 53.84% and 61.54%,respectively(p = 0.999).2.In patients receiving immunotherapy,the affected segment of spinal cord in the treatment non-response group was significantly more than that in the response group [5.00(3.00-9.00)vs 2.00(0.00-5.25),p = 0.020].Length of spinal lesion was negatively correlated with treatment response(r =-0.263,p = 0.019).Binary logistic analysis showed that after adjusting for confounding factors,the length of spinal cord lesions was an independent risk factor for predicting prognosis(OR = 0.84,95% CI 0.72,0.98,p =0.031).3.In the patients receiving immunotherapy,compared with non-response group,the serum albumin level in response group was significantly increased(39.16 ± 4.90 vs 42.49 ± 3.91,p = 0.002).There was a positive correlation between serum albumin levels and treatment response(r = 0.328,p = 0.003).Binary logistic analysis showed that serum albumin level on admission was an independent predictor of prognosis(OR=1.18,95%CI 1.00–1.39,p = 0.046)after adjusting for confounding factors.ROC analysis showed that when the albumin level was higher than41.15 g / L,the patients were more likely to get a favorable clinical outcome.The sensitivity of the prediction was 71.2%,and the specificity was 70.4%.4.The overall incidence of side effects was 46.81%.The incidences of side effects in the three groups were 48.48%,47.06% and 36.36%(p =0.765).The highest incidence of side effects was hyperglycemia(23.4%).Conclusion: This study shows that three treatment options were all effective and did not cause severe side effects,and had comparable treatment effects and no difference was seen in incidences of adverse effects.IVMP+PLEX treatment may make patients get a greater degree of disease relief.Patients with shorter spinal lesions and higher serum albumin levels tended to have a greater chance of an ideal clinical outcome.These two indicators can be used as predictors of the effect of immunotherapy. |
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