Impact Of Blood-brain Barrier Disruption On Newly Diagnosed Neuromyelitis Optica Spectrum Disorder Symptoms And Prognosis

Objectives:Investigate the relationships between BBB permeability as showed by the albumin quotient（qalb）and clinical features of NMOSD.Methods:Collect demographic and clinical data of 46 newly diagnosed acute phase NMOSD patients admitted in the Department of Neurology,the First Affiliated Hospital of Guangxi Medical University from 2017.1 to2019.3,including peripheral blood（PB）measures（serum albumin concentration and total leukocyte,neutrophil,total lymphocyte,CD4⁺T cell,and CD8⁺T cell counts,total T lymphocyte count,complement C3 and C4concentrations,AQP4-IgG titer）,autoimmune antibody titer（ANA/SSA/SSB/Ro-52）,and cerebrospinal fluid（CSF）parameters（total leukocyte count,total protein and albumin concentrations,AQP4-IgG titer）,MRI of the brain,optic nerve,cervical spine,thoracic spine.Complete measures were not obtained from 9 patients,but all other measures were included in the analysis.Results:According to the calculated qalb,15 patients with qalb>（4+age/15）×10^-3 were assigned to the qalb increased（high BBB permeability）group（33%）and the remainder to the qalb normal group.Compared to the qalb normal group,the qalb increased group exhibited significantly lower serum albumin（P=0.001）and CD4⁺T cell count（P=0.044）,CD8⁺T cell count（P=0.014）,and total T lymphocyte count（P=0.016）.The qalb increased group proved higher CSF albumin,CSF total protein,CSF IgG titer,CSF leukocyte count（P=0.001,0.001,0.001,0.007）.Optic neuritis and optic nerve abnormalities on magnetic resonance images were also more frequent in the qalb increased group（P=0.037 and 0.038,respectively）.Patients in the qalb increased group showed significantly poorer treatment response as indicated by the lower post-treatment change in Expanded Disability Status Scale（EDSS）score compared to the qalb normal group（P=0.028）.Conclusions:BBB permeability is strongly associated with the clinical features and treatment response of newly diagnosed acute phase NMOSD.The qalb is a potentially valuable indicator of disease severity and an index to guide personalized treatment.