The Analysis Of Clinical And Radiological On MOG And AQP4 Antibody Positive NMOSD Patients

ObjectiveNeuromyelitis optic(NMO)is a central nervous system demyelinating disease mediated by humoral immunity.It is more common in Asian young women.The clinical symptoms involve the optic nerve and spinal cord,and the recurrence rate is high and the prognosis is poor.The discovery and in-depth study of Aquaporin-4 antibodies(AQP4-IgG)allowed them to be isolated from multiple sclerosis and promoted the new diagnostic criteria for Neuromyelitis optica spectrum disorders(NMOSD)in 2015,which focuses on patient clinical features,magnetic resonance imaging and laboratory testing,and divides them into AQP4-IgG positive and negative groups.Recent studies have found that some patients with AQP4-IgG negative patients have Myelin oligodendrocyte glycoprotein antibody(MOG-IgG),and its clinical features are different from those of AQP4-IgG positive patients,suggesting that MOG-IgG may represent another pathogenesis.At present,there are few studies on the clinical and imaging features of MOG-IgG positive NMOSD patients in China.This study compared the clinical and imaging features of MOG-IgG positive and AQP4-IgG positive patients,hope to improve the clinical understanding of NMOSD,reduce the rate of missed diagnosis and misdiagnosis,give patients timely and correct treatment,improve the quality of life of patients.MethodsThis study collected 139 cases of NMOSD patients diagnosed from the Department of Neurology,Zhengzhou University’s Fifth Affiliated Hospital and the First Affiliated Hospital of Zhengzhou University from January 2016 to February 2018 and according to the NMOSD diagnostic criteria revised by the 2015 International NMO Diagnostic Group.All patients were tested for AQP4-IgG and MOG-IgG by CBA,and there were no other serious medical diseases.The study could be signed and informed consent was signed.According to the results of serological antibody detection,patients with AQP4-IgG and MOG-IgG single positive were selected as the study subjects.The general data,clinical characteristics,laboratory test indicators,neurophysiological test indicators and imaging findings of the two groups were recorded and compared.Patients were followed up for 6-30 months to observe whether there was any recurrence during the follow-up period.All patients underwent an acute EDSS score before formal treatment,and a remission EDSS score was given after regular treatment.Results1.The proportion of AQP4-IgG single positive patients was 70.5%(98/139),AQP4-IgG negative patients 28.8%(40/139),MOG-IgG single positive patients 8.6%(12/139),double positive patients 0.7%(1/139),double negative patients 20.1%(28/139).The MOG-IgG single positive patients were more common in men(66.7%),and the AQP4-IgG single positive group was predominantly female(78.6%).The difference in gender composition between the two groups was statistically significant(P <0.01),while there was no significant difference in the age of onset of the patients(P >0.05).2.In the MOG-IgG group,the optic nerve and spinal cord were often involved at the sametime(83.3%),andismainlyaffectedbilateral optic nerve(P <0.05),and most patients presented a single disease course(P <0.01).There was no significant difference in the EDSS score between the MOG-IgG group and the AQP4-IgG group(P >0.05).The EDSS score in the remission period was lower than that in the AQP4-IgG group(P <0.01).There were no significant differences in the duration of disease,autoimmune antibodies,cerebrospinal fluid test,and neurophysiological test results between the two groups(P >0.05).3.All patients in the MOG-IgG group had spinal cord abnormalities and the proportion of patients in the AQP4-IgG group was 87.8%,the difference was not significant(P > 0.05).The lesions of the former involve the thoracic cord(91.7%)and the lumbar cord(50.0%),and the cervical spinal cord(33.3%)is rare.The latter involves the cervical spinal cord(68.4%)and the thoracic cord(67.3%),while lumbar cord(8.2%)is relatively rare.The difference of cervical spinal cord and lumbar spinal cord between the two groups is statistically significant.(P <0.05;P <0.01)。The intracranial lesions of the AQP4-IgG group were more common than those of the MOG-IgG group,with a respectively ratio of 97% and 25%.37.8% of patients in the AQP4-IgG group had lesions in the posterior medullary region,which was higher than the MOG-IgG group(8.3%)and the difference was statistically significant(P < 0.05).43.9% of patients in the AQP4-IgG group had lesions around the intracranial ventricle system(21.4% around the ventricles,13.3% around the third ventricle,3.0% around the aqueduct,and 15.3% around the fourth ventricle),and the lesions in other parts of the brain accounted for 53.1.%(18.3% under the cortex,17.3% brain stem,9.8% carcass,7.1% basal ganglia).In the MOG-IgG group,no lesions around the ventricular system were found.The lesions in other parts of the brain were present in 25.0% of patients(8.3% under the cortex,16.7% in the brainstem,8.3% in the corpus callosum).The intracranial lesions around the ventricular system between the two groups.Statistically significant(P <0.01).There were no statistically significant differences between the two groups in the involvement of the thoracic spinal cord,more than three spinal cord segments,the total length of the spinal cord,and other intracranial lesions(P >0.05).ConclusionCompared with AQP4-IgG positive patients,MOG-IgG positive patients are more common in men,clinical symptoms are more involved in the optic nerve and spinal cordandismainlyaffectedbilateral optic nerve.The spinal cord lesions are more common in the lumbar spine,and the cervical spinal cord involvement is relatively rare.The lesions around the intracranial ventricle system and the posterior medulla oblongata lesions are less,showing a single disease course and a better prognosis.