The Characteristics Of Recurrence And Transformation Of Inflammatory Demyelinating Lesions Of Spinal Cord And Its Relationship With Anxiety And Depression

Objective1.Retrospective study was conducted on the clinical data of patients with single inflammatory demyelinating lesion of spinal cord as the first manifestation,and the factors influencing its recurrence and transformation were summarized.2.Prospective study was conducted on patients with single inflammatory demyelinating lesion of spinal cord as the first manifestation,and the relationship between anxiety,depression and daily living ability,recurrence and disability degree was summarized.Methods1.Clinical data of 92 patients with single inflammatory demyelinating lesions of spinal cord were collected from January 2015 to December 2021 in the Department of Neurology,The Second Hospital of Shandong University.Including clinical manifestations,course of disease,disability status,length of spinal segment,recurrence,serum and CSF demyelinating antibody of central nervous system,serum and CSF oligoclonal bands,CSF proteins,serum potassium,serum sodium,thyroid antibodies,rheumatoid series antibodies,EDSS score,ADL scale and so on.Patients with such diseases were divided into the transformation group and the non-transformation group according to whether there was transformation to NMOSD,MS,MOG and other diseases in the follow-up process.Statistical software SPSS 22.0 was used to analyze whether there was statistical difference in clinical data between the two groups.2.Clinical data of 71 patients with single inflammatory demyelinating lesions of spinal cord in the Department of Neurology,The Second Hospital of Shandong University from August 2019 to December 2021 were collected.HAMA,HAMD,SAS,SDS,ADL and other scales were used to evaluate them.As well as their admission,discharge and outpatient visit for more than 1 month for EDSS score.HAMA score,HAMD score as the diagnosis of anxiety state,depression state "gold standard",using grouped into anxiety group,non-anxiety group,depression group,non-depression group.Statistical software SPSS 22.0 was used to analyze the relationship between anxiety and depression,including daily living ability,degree of disability,length of spinal segment,recurrence,pain,age,gender and other factors.Results1.Our retrospective study of 92 patients found that the transformation of single inflammatory demyelinating lesion of spinal cord was related to multiple factors,including age,segments of spinal cord≥3(P<0.05).It was related with rheumatism series abnormality,positive demyelinating antibody of central nervous system and recurrence(P<0.01).Patients with onset before 40 years old,recurrence within 1 year of the first onset and ANA≥1:320 were more likely to develop transformation.There was no statistical significance with sex,inducer,follow-up period,clinical manifestation,serum potassium,serum sodium,thyroid antibody,ESR,abnormal CSF protein,serum and CSF oligoclonal band(P>0.05).2.Binary Logistic regression analysis showed that whether there was recurrence(OR=6.850,OR 95%confidence interval 2.206-21.270,P=0.001),segments of spinal cord≥3(OR=3.434,OR 95%confidence interval 1.002-11.771,P=0.049)and positive demyelinating antibody of central nervous system(OR=19.983,OR 95%confidence interval 2.258-176.816,P=0.007).The results further indicated that whether there was recurrence,segments of spinal cord≥3,and the positive demyelinating antibody of central nervous system were independent risk factors for the transformation of single inflammatory demyelinating lesion of spinal cord to NMOSD,MS,MOG and other diseases.3.Our prospective study of 71 patients with single inflammatory demyelination of spinal cord showed that patients with single inflammatory demyelination of spinal cord were more likely to be associated with anxiety and depression than the normal control population(P<0.01).Anxiety was significantly correlated with the degree of disability(EDSS score r1)and daily living ability(ADL score r2)(r1=0.48,r2=-0.38,P<0.01).Depression was significantly correlated with the degree of disability(EDSS score,r3)and daily living ability(ADL score,r4)(r3=0.40,r4=-0.46,P<0.01).In addition,it can be concluded that the anxiety and depression of the patient in this case is not related to the length of spinal cord lesion segment,recurrence,transformation,pain,age,gender,rheumatic series abnormalities and other factors(P>0.05).Non-parametric test showed that EDSS score on admission,EDSS score on discharge and ADL score had no statistical significance on whether patients had transformation or recurrence(P>0.05).4.Our prospective study of 71 patients with single inflammatory demyelinating lesion of spinal cord also found that HAMA score was significantly positively correlated with somatic factor score(r=0.86,P<0.01),HAMA score was negatively correlated with ADL score(r=-0.381,P<0.01),and HAMA score was significantly positively correlated with HAMD score(r=0.87,P<0.01).HAMA scale score(Y)was linearly correlated with ADL(X1),HAMA body factor(X2)and HAMD score(X3).After calculation,Y=-9.933+0.064X1+1.008X2+0.255X3.Conclusions1.A single outcome of spinal inflammatory demyelinating lesions associated with a variety of factors,this study has found that age at first onset,segments of spinal cord≥3,central nervous demyelinating antibody positive,rheumatism series antibody abnormalities,single inflammatory demyelinating lesions in patients with spinal cord disease recurrence is easier to appear into NMOSD,MS,MOG and other demyelinating diseases of the central nervous system.And such patients if the onset of the disease before 40 years old,the first attack within 1 year relapse or aggravation of the disease,more suggests the possibility of disease transformation;2.Recurrence,segments of spinal cord ≥ 3,and positive central nervous system demyelinating antibody were independent risk factors affecting the transformation of a single inflammatory demyelinating lesion of spinal cord into NMOSD,MS,MOG and other demyelinating diseases of the central nervous system.3.Compared with the healthy controls,the patients with single inflammatory demyelinating lesions of spinal cord were more likely to be complicated with anxiety and depression,and the degree of anxiety and depression were significantly correlated with the degree of disability and the ability of daily living.4.The anxiety degree of patients with single inflammatory demyelinating lesions of spinal cord has multiple linear correlation with daily living ability,somatic factors and depression degree,indicating that early treatment and rehabilitation of the disease is of great significance to the mental health of patients with demyelinating lesions of spinal cord.