Clinical Analysis Of Acute LESCLs Between AQP4-Ab Seropositive And Seronegative NMOSD

Object To investigate the relationship of AQP4 antibody status to the length of spinal cord lesion,clinical manifestation and prognosisin LESCLs of acute NMOSD and further analyze prognosisof AQP4-Ab seropositive LESCLs in age,CSF MBP.Methods We retrospectively screened 94 consecutive patients diagnosed of NMOSD with acute LESCLsfrom Xuanwu Hospital between 2012-10-01 to 2017-02-15.Among them,AQP4 antibodies were detected in 90 cases(75 positive,15 negative).They were divided into serum AQP4-Ab positive and negative group.The clinical features were reviewed and rehospitalized patients were followed up.Data was collated with their gender,age,symptoms,time from last episode,distribution of MRI lesion,length of LESCLs,EDSS score,biomarkers related to demyelination and immunologicalstatus such as myelin basic protein(MBP)and so on.Statistical analyses were performed using SPSS 24.0.All measurement data were not consistent with normal distribution by KS test.Characteristics were compared between patient groups by using χ2(or Fisher exact)tests for categorical data and Mann-Whitney U tests for continuous data.Spearman’s rho was assessed to test for correlations.P<0.05 was considered statistically significant.Results 83.3% of patients with LESCLs of acute NMOSD were AQP4-Ab seropositive,compared with seronegative LESCLs,they were later onset,with less acute opticneuritis,have longer median length ofaverage single lesions and total lesions of spinal cord,more likely to be positive for tumor markers and have a lower titer of complement C4.But no significant differences were found among the sex ratio,EDSS score,annual recurrence rate,autoimmune disease ratio,median length of the longest lesion in the spinal cord.The acute phase EDSS score was positively correlated with cerebrospinal fluid AQP4-Ab titer,CSF:serum AQP4-Ab ratio and cerebrospinal fluid protein level,and the annual recurrence rate(ARR)was positively correlated with Ig G index.Neither EDSS nor ARR was related to the length of spinal cord or serum AQP4-Ab titer.In AQP4-Ab seropositive group,CSF MBP positive patients and older patients(age>50)were more disabled.Conclusions(1)AQP4-Ab seropositive LESCLsof acute NMOSD have more obvious spinal cord involvement,they are more often later onset(>50 years old),accompanied with positive tumor markers.(2)CSF MBP positive or patients over 50 years old were more disabled in AQP4-Ab seropositive patients.(3)Cerebrospinal fluid AQP4-Ab titer,CSF:serum AQP4-Ab ratio and cerebrospinal fluid protein can be used to evaluate the severity of disease,Ig G index can be used as predictor of recurrence.