| Background and purposeNeuromyelitica optica spectrum disorders(NMOSD)is a group of inflammatory demyelinating diseases of the central nervous system.Serum aquaporin-4(AQP4)antibody is a specific marker and as an important basis for the stratified diagnosis of NMOSD.With the in-depth study of NMOSD,it has been found that NMOSD is mainly mediated by humoral immunity,and is an autoimmune disease of the central nervous system that involves in other immune pathways.However,the pathogenesis of NMOSD is complex and has not been fully elucidated.Studies have shown that inflammatory cells and cytokines play an important role in the pathogenesis of NMOSD.Interleukin-18(interleukin-18,IL-18)is a cytokine IL-1 over one of the members of this family,have a variety of biological function,can promote the activation of T cells proliferation,enhance NK cell cytotoxic effect,and can be induced by Interferon-?(Interferon-?,IFN-?)production and play a role of strong proinflammatory,as proinflammatory cytokines,IL-18 involved in systemic lupus erythematosus,rheumatoid arthritis,multiple sclerosis and other autoimmune disease development,It is speculated that IL-18 may play a role in the course of NMOSD disease.Interleukin 37(IL-37)is a new member of the IL-1 family.Studies have shown that IL-37 inhibits the expression of various inflammatory cytokines and is a natural immunosuppressor.IL-37 can be induced by dendritic cells and peripheral blood mononuclear cells,and is highly expressed in inflammatory tissues,which can inhibit excessive inflammatory response in autoimmune diseases.A number of studies in recent years have found abnormal expression of IL-37 in systemic lupus eryth ematosus,rheumatoid arthritis and other autoimmune diseases.Whether IL-37 plays a certain role is the pathogenesis and outcome of NMOSD remains to be further explored.Given the current IL-18 and IL-37 in NMOSD incidence and outcome in the course of action is not yet clear,we proposed by detecting NMOSD patients serum IL-18 and the concentration of IL-37,analysis of the two kinds of cytokines and other clinical indicators NMOSD correlation,explore the pathogenesis of these two kinds of cytokines in NMOSD and outcome may play a role in the process of,in order to NMOSD immune provide further theoretical basis for treatment.MethodsA retrospective case-control study was conducted.Thirty-two patients with optic neuromyelitis spectrum disease who visited the department of neurology of the first affiliated hospital of zhengzhou thniversity from September 2017 to December 2019 were selected,including 27 females and 5 males as the experimental group.By a doctor ask for details of all the patients were the history and the specialized examination of nervous system,a complete history records(including name,sex,age,starting symptoms,causes,acute phase of the Expanded disability status scale(Expanded disability status scale,EDSS)score(see appendix 2),recurrence rate and time interval,auxiliary examination,etc.).Meanwhile,26 healthy volunteers who came to our hospital for physical examination at the same time were selected as the experimental control group,including 9 males and 17 females.Peripheral venous blood samples were collected.Serum exprcssion leveis of IL-18 and IL-37 in patients and healthy volunteers were determined by enzyme linked immunosorbent assay(ELISA).SPSS21.0 software package was used to process all data,and mean±standard deviation was used to represent quantitative data.Two independent sample t test was used to compare the quantitative data of two groups of independent samples.Paired t test was used to compare the quantitative data of two groups of samples.2 test was used to compare the two groups of dichotomous data 0.05,indicating that the difference was statistically significant.Results(1)The incidence of serum IL-18 level in NMOSD acute stage,group was 201.54±83.08ng/L,the serum IL-18 level in NMOSD group was 159.54±35.34ng/L,and the serum IL-18 level in healthy control group was 131.01±20.96ng/L.The level of IL-18 in the acute stage of NMOSD was higher than that in the remission stage,and the difference was statistically significant(P=0.001).The level of IL-18 in the NMOSD group in the acute phase was higher than that in the healthy control group,and the difference was statistically significant(P<0.001).The level of IL-18 in remission was higher in the NMOSD group than in the healthy control group,and the difference was statistically significant(P=0.001).Serum IL-18 level in the acute phase of NMOSD was positively correlated with patients' EDSS score(r=0.679,P<0.001).Serum IL-18 level in the acute phase of NMOSD had no correlation with the length of spinal cord lesions(r=0.063,P=0.755).There was no statistically significant difference in.serum IL-18 levels between the AQP4 positive group and the negative group(P=0.604).(2)The incidence of serum IL-37 level in NMOSD acute stage,remission stage and healthy control group was 244.62±9.84pg/ml,261.74±32.94pg/ml,and 224.83±25.97pg/ml in the acute phase,remission phase and healthy control groups,respectively.The level of IL-37 in NMOSD remission stage was higher than that in the acute stage,and the difference was statistically significant(P=0.008).The level of IL-37 in the acute stage of NMOSD was high er than that of the healthy control group,and the difference was statistically significant(P=0.001).The level of IL-37 in the NMOSD group in remission was higher than that in the healthy control group,and the difference was statistically significant(P<0.001).Serum IL-37 level of NMOSD in the acute phase was positively correlated with EDSS score of patients in the acute phase,r=0.536,P=0.002.Serum IL-37 level in the acute phase of.NMOSD had no significant correlation with the length of spinal cord lesions(r=0.103,P=0.608).There was no significant difference in serum IL-37 levels between the AQP4 positive group and the negative group(P=0.187).Serum IL-37 level was positively correlated with IL-18 level in NMOSD patients in the acute phase,r=0.354,P<0.05.Conclusion(1)The level of IL-18 increased in both the acute and remission stages of NMOSD,and the acute stage was more significant.Considering that IL-18 mainly plays a pro-inflammatory role in the onset and acute exacerbation stages and is related to the severity of the disease,it could be considered as an indicator to predict the severity of the disease.(2)The level of IL-37 increased in both the acute and remission stages of NMOSD,,and the increase in the acute stage was considered to reduce the excessive inflammatory response,while the increase in the recovery stage was more significant,considering that it may play an anti-inflammatory role mainly in the recovery stage.(3)In the acute phase of NMOSD,IL-37 was positively correlated with the level of IL-18.Considering that IL-18 can promote the expression of IL-37,they both can as a reference index for the diagnosis and treatment of NMOSD. |
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