The Clinical Significance Of Lymphocyte Subsets And Serum IL-35 Level In Patients With Neuromyelitis Optica Spectrum Disorders

ObjectiveTo explore the association between the whole blood CD4 cell level and physical disability in patients with Neuromyelitis Optica Spectrum Disorders(NMOSD),also to explore the function of IL-35 by testing the serum concentration of IL-35 during the different stages of NMOSD.We want to identify whether the whole blood CD4 level and IL-35 level can be used to diagnose the disease and help us to estimate prognosis.MethodsThe first part: Clinical and biochemical data of 58 patients with NMOSD were retrospectively analyzed in department of neurology at Shanghai First Rehibilitation Hostipal and Renji Hospital affiliated to Shanghai Jiao Tong University from January 2015 to June 2016.According to Expanded Disability Status Scale(EDSS),NMOSD patients were divided into groups with independent walking and assisted walking,and their clinical and biochemical characteristics were compared between the two groups,then the association between whole blood CD4 cell level and physical disability was analyzed.The second part: Clinical and biochemical data of 58 patients with NMOSD were analyzed in department of neurology at Shanghai First Rehibilitation Hostipal and Renji Hospital affiliated to Shanghai Jiao Tong University from January 2015 to June 2016.According to different stage of the disease,NMOSD patients were divided into groups with acute phase and chronic phase,also 36 healthy control people were included.We tested serum IL-35 level by the sandwich-type Enzyme Linked Immunosorbent Assay(ELISA)and analyzed the difference among different groups and its clinical significance.ResultsThe first part: Between the groups with independent walking and assisted walking,there are no significant differences in gender,infection,symptoms of optic nerve,sensory symptoms of spinal cord,CD3?CD8?CD19?CD4/CD8 and NK level(P>0.05),and there are statistically significant differences in age,spinal motor symptoms,autonomic symptoms and CD4 cell level.CD4 cell level is negatively correlated with physical disability(r=-0.480,P<0.01).The second part: Between the groups with acute phase and chronic phase,there are no significant differences in gender,symptoms of optic nerve,intracranial involvement,cervical spinal cord involvement,thoracic spinal cord involvement,aquaporin 4,white blood cells and neutrophilic granulocytes in blood,and there are statistically significant differences in age,score of Expanded Disability Status Scale(EDSS),blood level of folic acid,protein in cerebrospinal fluid.The serum IL-35 level in acute phase of NMOSD patients is declined significantly compared to the chronic phase and healthy control groups(p<0.001;p<0.0001).Serum IL-35 level is negatively correlated with score of EDSS and protein in cerebrospinal fluid(r=-0.35,P< 0.05;r=-0.54,P< 0.001).ConclusionsThe higher of the CD4 cell level,the lower of incidence of physical disability.The CD4 cell level may helpful in immunologic mechanism of physical disability in NMOSD patients.The decreased level of serum IL-35 in acute phase of NMOSD patients indicates that the IL-35 has its own role of immunosuppression in NMOSD.