合并免疫指标异常的视神经脊髓炎临床特点

【】　目的　分析合并免疫指标异常的视神经脊髓炎临床特点。　方法　回顾性分析2009年5月-2010年11月收治的62例视神经脊髓炎患者中24例合并免疫指标异常患者的临床资料。24例均为女性，发病年龄14~53岁。对其临床表现、视觉诱发电位、影像学检查结果、免疫检查结果进行分析。　结果　所有患者均有脊髓和视神经同时或先后受累的表现。24例视觉诱发电位检查23例异常。脊髓MRI显示病变集中于颈段、上胸段脊髓。颈段和胸段脊髓同时受累17例，单纯颈段脊髓受损6例，单纯胸段脊髓受损1例。所有患者抗核抗体滴度均≥1∶100，合并抗SSA抗体阳性14例（55.5％），同时合并抗SSB抗体阳性11例（45.8％），合并抗Rib抗体阳性1例，合并抗SCL-70抗体阳性1例，合并抗dsDNA抗体1例。　结论　视神经脊髓炎合并免疫指标异常的患者以女性较为多见，易复发，青壮年患者发病率最高。脊髓MRI示病变集中于颈段、上胸段脊髓，表现为长节段脊髓损害。视神经脊髓炎患者合并结缔组织病的病例较多。【Abstract】　Objective　Toanalyzetheclinicalfeaturesofneuromyelitisoptica(NMO)combinedwithabnormalimmuneparameters.　Methods　Weretrospectivelyreviewedtheclinicaldataof24patientswithNMOandabnormalimmuneparametersamongthe62NMOpatientswhowereadmittedintoourdepartmentbetweenMay2009andNovember2010.Allpatientswerefemale,agedfrom14to53years.Weanalyzedtheirclinicalmanifestations,visualevokedpotentials,imagingresults,andimmunologicalexaminations.　Results　Allpatientshadsimultaneousorsuccessivespinalcordandopticnerveinvolvement.Twenty-threepatientshadabnormalvisualevokedpotential.MRIshowedthatthelesionsfocusedonthecervicalandupperthoracicspinalcord.Bothcervicalandthoracicspinalcordwereinvolvedin17cases;therewere6casesofsimplecervicalspinalcordinjuryand1caseofsimplethoracicspinalcorddamage.Antinuclearantibodytiterofallthepatientswas≥1∶100.Combinedpositiveanti-SSAantibodyoccurredin14patients(55.5%);Concomitantpositiveanti-SSBantibodiesoccurredin11patients(45.8%);Combinedpositiveanti-Ribantibodiesoccurredin1patient;Combinedpositiveanti-SCL-70antibodyoccurredin1patient;andcombinedpositiveanti-dsDNAantibodiesoccurredin1patient.　Conclusions　NMOcombinedwithabnormalimmuneparametersmainlyoccursinfemalepatients,especiallyinyoungpeople.Recurrencerateishigh.MRIshowsthatthelesionsfocusmainlyonthecervicalandupperthoracicspinalcord,manifestingthecharacteristicoflongsegmentdamage.AndNMOisfrequentlycombinedwithconnectivetissuedisease.