The Analysis On Clinical And Imageological Features Of Neuromyelitis Optica With Positive Autoantibodies

Objective:To analyze the clinical and imageological features of neuromyelitis optica(NMO) with positive autoantibodies.Methods:In this retrospective study,forty three patients who were diagnosed NMO in the department of neurology belongs to the first affiliated hospital of Guangxi Medical Universtity were collected from September,2013 to September,2014.All patients were gave the pulse therapy of glucocorticoid in acute phase(methylprednisolone 1.0g×3d and then 0.5g X 3d).Checked all patients’ serum autoantibodies such as anti-nuclear antibody(ANA),anti-SSA antibody, anti-SSB antibody, anti-Ro-52 antibody and anti-nucleosome antibody. According to the situation of the autoantibodies,there were thirteen patients in the autoantibody-positive group and thirty patients in the autoantibody-negative group.To compare the clinical and imageological features,the situation of relapse,the score of expanded disability status scale(EDSS) in the initial attack,the score of EDSS after the pulse therapy of glucocorticoid and in remission. Statistical analysis was applied in SPSS 16.0 software.The difference was statistically significant when the P value was lesser than 0.05.Results:(1)Most of NMO patients were female.30.2% of the autoantibodies were positive.Among them,ANA was 25.6% and anti-SSA antibody accounted for 16.3%.(2)In the autoantibody-positive group,a number of patients began with optic neuritis,monocular or binocular blindness and more double optic neurologic involved.The rate of relapse at the first year in the autoantibody-positive group was higher than the negative group and the difference was statistically significant(61.5% vs 23.3%,P<0.05). (3) The score of EDSS in the initial attack,follow-up at six months and follow-up at twelve months in the autoantibody-positive group were higher than the negative group,the differences between the two groups were statistically significant(P< 0.05).As time went on,the score of EDSS in the two groups reduced obviously to the contrast with the initial attack and the differences were statistically significant(P<0.05).The reduction was higher in the negative group.All patients’ score of EDSS reduced after the pulse therapy of glucocorticoid and the reduction was higher in the positive group(P<0.05).(4) The comparison of CSF in nucleated cells, cerebrospinal pressure, immunoglobulin G(IgG) and cerebrospinal fluid protein between two groups didn’t have statistical difference(P> 0.05).(5)The section of spinal cord damage in the autoantibody-positive group was longer than the negative group(8.460±3.503 vs 5.200±3.145,P<0.05). The appearance and distribution of brain damage in the cranial imaging didn’t have statistical difference between the two groups(P> 0.05), most of brain lesions were around the ventricles and brain stem.Conclusion:NMO patients whose autoantibodies were positive were more serious in the injury of neurological function at the initial attack,longer in the section of spinal cord damage,lower sensitivity to the pulse therapy of glucocorticoid in acute phase,more serious in the disability and higher in the rate of relapse at the first year.