| Objective:To analyze the relationship between segmental length,position and cross-sectional area of spinal cord lesions with clinical prognosis and serum anti-aquaporin 4 antibody titer in NMOSD patients.Methods:1.Fifty-four NMOSD patients with positive serum anti-aquaporin 4antibody and myelitis from the First Affiliated Hospital of China Medical University from August of 2016 to February of 2018 were enrolled.2.Detection of serum anti-aquaporin 4 antibody:indirect immunofluorescence assay based on stable expression of AQP4 cells was used to detect serum anti-AQP4 antibody;3.Extended Disorder Status Scale(EDSS)was used to assess the extent of neurological deficits at the onset of disease,follow-up of 3~rdd months,6~thh months,and 1~stt year.4.Examination of imaging:using Germany Siemens 3.0T magnetic resonance imaging system to measure the segmental length and position,using Philips IntelliSpace Portal Nebula 3D diagnostic imaging system to measure cross-sectional area of spinal cord lesion.5.Patients were divided into four groups according to the length of the spinal cord lesions:S1(1-2 spinal segments,10 cases).S2(3-6 segments,29 cases),S3(7-10 segments,11 cases),S4(11-15 segments,4cases).6.Patients were divided into three groups according to the position of the spinal cord lesions,P1 group(the lesion was located in the neck segment,20 cases),P2 group(the lesion was located in the neck and thoracic segment,19 cases),and P3 group(the lesion was located in the thoracic segment,15 cases);7.According to the cross-sectional area of spinal cord lesions,patients were divided into two groups:A1group(area of the lesion is larger than 50%of spinal cord at the same cross-section,20cases),A2 groups(area of the lesion is less than 50%of spinal cord at the same cross-section,34 cases);8.Analysis of differences and correlation analysis between groups was operated with SPSS20.0 statistical software.Results:1.The EDSS scores at the onset of disease of S1,S2,S3,and S4 groups were4.2±2.0,5.3±2.1,6.6±1.9,and 7.3±1.8 respectively,and the differences between groups were statistically significant(P=0.02).The correlation analysis showed that there was a positive correlation between the EDSS scores at the onset of disease and the length of spinal cord lesions(r=0.42,P=0.002).There was no significant difference in the EDSS scores between the groups at the follow-up of 3~rdd month,6~thh month,and 1~stt year(P>0.05);The median of serum AQP4-IgG titers in S1,S2,S2,and S4 groups were 1:32,1:64,1:128,and 1:480 respectively.Correlation analysis showed that there was a positive correlation between the length of the spinal cord segment and serum AQP4-IgG titers(r=0.553,P<0.001).2.There were no significant differences in the EDSS scores between the P1 group,the P2 group and the P3 group at the onset of disease,follow-up of 3~rdd month,6~thh month,and 1~stt year(P>0.05).3.There was no significant difference betweenA1 and A2 groups on the EDSS score at the time of onset and follow-up of 3~rdd month(P>0.05),there was significant difference between A1 and A2 groups at follow-up of 6~thh month(P=0.045)and follow-up of 1~stt year(P=0.025).Conclusion:1.The longer the initial spinal cord lesion segment in NMOSD patients,the more severe the clinical manifestations of patients and higher titer of serum AQP4antibody at onset of disease,but the length of spinal cord lesion does not affect long-term clinical prognosis.2.The location of the spinal cord lesions in NMOSD patients does not affect clinical prognosis at onset of disease and long-time follow-up.3.The cross-sectional area of spinal cord lesions in NMOSD patients does not affect the clinical manifestations of patients at the time of onset,but the larger the cross-sectional area of lesion,the worse the clinical prognosis of long-time follow-up. |
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