Comparative Analysis Of Clinical Features Of AQP4-IgG Positive And Negative With Neuromyelitis Optica Spectrum Disorders

Objectives:The characteristics of Aquaporin4-IgG positive and negative NMOSD patients in clinical manifestations,imaging characteristics,laboratory examination,the first diagnosis department situation and other aspects were analyzed.Through the analysis of the differences in clinical characteristics between Aquaporin4-IgG positive and negative NMOSD patients,the heterogeneity based on clinical and pathological mechanisms of NMOSD was further discussed.In order to better guide clinical diagnosis and treatment,reduce missed diagnosis,misdiagnosis.Methods:The serum Aquaporin4-IgG level was detected by indirect immunofluorescence assay(ELISA)after treatment in our hospital from January 2015 to January 2019.01.The2015 version of NMOSD was used as the diagnostic standard,and the final diagnosis was made in 52 patients with NMOSD.According to test results divided the patients into Aquaporin4-IgG positive group and negative group,through the analysis of two groups of clinical manifestations,imaging features and laboratory tests,the first clinical departments,recurrence,observe two groups in age,sex,onset of first symptom,expanded disability rating scale(EDSS),spinal cord involvement segment length,whether with intracranial lesions,whether with other autoimmune antibody,was whether have differences on clinical departments,relapse.Results:(1)of the 52 patients,40 were Aquaporin4-IgG positive,12 were negative,35 were female and 5 were male.The negative group included 7 females and 5 males.The onset age was 16-65 years old,and the average onset age was 39 years old.(2)detection results of other autoimmune antibodies: among 52 patients with NMOSD,17 were combined with other autoimmune antibodies,among which 16 patients with positive Aquaporin4-IgG were combined with other autoimmuneantibodies,and 24 patients without other autoimmune antibodies.Negative group with other autoimmune antibodies in 1 case,not with other autoimmune antibodies in 11 cases.(3)recurrence frequency: among 52 patients with NMOSD,28 patients had recurrence more than or equal to 2 times,and 24 patients had recurrence less than 2times.Among the Aquaporin4-IgG positive patients,25 cases had more than 2 times of recurrence,and 15 cases had less than 2 times of recurrence.Among Aquaporin4-IgG negative patients,3 cases had more than 2 times of recurrence,and 9 cases had less than 2 times of recurrence.(4)EDSS score: the score of Aquaporin4-IgG positive patients was 4.68 1.76,while the score of Aquaporin4-IgG negative patients was 4.92 1.38.(range 1.5-9.5 points).(5)involvement of spinal segment length and intracranial lesions: among 52 patients with NMOSD,34 had spinal involvement of more than 3 segments;Among them,11 patients with Aquaporin4-IgG positive spinal cord MRI involvement length did not exceed 3 segments,and 29 patients with more than 3 segments.The length of spinal cord MRI involvement in Aquaporin4-IgG negative patients was less than 3 segments in 7 cases,and more than 3 segments in 5 cases.Among the 52 NMOSD patients with intracranial lesions,there were 12 cases;among the Aquaporin4-IgG positive patients,there were 9 cases with intracranial MRI lesions and 31 cases without intracranial lesions.Among the Aquaporin4-IgG negative patients,there were 3 patients with intracranial lesions associated with head MRI,and 9 patients without intracranial lesions.(6)department of first diagnosis: among the Aquaporin4-IgG positive patients,33 were admitted to neurology department and 7 to non-neurology department.Among Aquaporin4-IgG negative patients,3 were admitted to neurology department and 9 to non-neurology department.Conclusion:1.The disease spectrum of optic neuromyelitis mostly occurs in young and middleaged women,and the incidence and recurrence rate of Aquaporin4-IgG positive group is higher than that of the negative group;2.NMOSD starting clinical symptoms are diverse,mainly for optic neuritis and(or)myelitis,intractable hiccups and skin paresthesia,Aquaporin4-IgG positive group and negative group two groups in the clinic department for the first time,Aquaporin4-IgG positive neurology JiuZhenLv higher than negative group,patients with negative group of missed diagnosis and misdiagnosis rate is high,in the positive group such patients should cause the attention of clinicians,reduce missed diagnosis;3.The length of spinal involvement segment in the Aquaporin4-IgG positive group was longer than that in the negative group,and the detection rate of other autoimmune antibodies was higher than that in the negative group,suggesting that other serum autoimmune antibodies may be involved in the pathogenesis of NMOSD.Positive serum Aquaporin4-IgG affects the recurrence frequency of NMOSD,and patients with positive serum Aquaporin4-IgG have a high recurrence rate and poor prognosis.There were no significant differences in age,intracranial lesions,and extended disability scale score(EDSS)between the two groups.