Establishment Of Detection Platform Of Antibody To Aquaporin-4and It’s Clinical Significance

Objectives:To construct an web-based medical data bank for the demyelinating diseases in the central nervous system and analyse the clinical characters of this kind of diseases; To set up a platform for the detection of aquaporin-4antibody(AQP-4Ab) in the serum of the patients with the demyelinating diseases in the central nervous system and assess it’s clinical significance.Methods:(1)The data bank was constructed based on the Access sofetware, combined with advanced computer and web technology. With the contribution of the data bank, the clinical features of the NMO and MS patients were analysed retrospectively.(2) A platform for the detection of AQP-4Ab was set up, which consisted of CBA, FIPA and FACS assays. The AQP-4Ab was detected by the three assays in33NMO and29MS patients respectively. The sensitivity, specificity and correspondence were analyzed.(3) The AQP-4Ab in the sera of the patients suffered from demyelinating diseases were tested, the clinical significance of the AQP-4Ab was evaluated.Results:(1) A web-based data bank for demyelinating diseases in the central nervous system was constructed. Relapsing and remitting was also a feature of NMO, as in MS. NMO predominantly affected middle-aged women. The severe onset, early relapse may lead to a poor prognosis. NMO could be complicated with other systemic autoimmune diseases. NMO lesions were characterized by extensive demyelination with partial necrosis in the spinal cord, involing both grey and white matter, usually extending over3segments and could have spinal atropy. The brain MRI at the onset was always normal in NMO, and after the first episode,41.7%patients could have intracranial focus, most of which located on the periventricular area, subcortical white matter and brain stem. While spinal cord lesions in MS patients were less than three segments, and the intracranial focus displayed an ovoid shape located on the centrum semiovale, periventricular area, corpus callosum, brain stem and cerebellum, etc.(2) All the three assays demonstrated excellent specificity (100%) for NMO, while CBA had a superior sensitivity (87.9%). FIPA and FACS could be used for clinical diagnosis more easily.(3) AQP-4antibody positive ratios in the NMO, LETM, ON and CIS, were87.0%,75.0%,66.7%,4.8%respectively; and AQP-4antibody was negative in MS group;(3)The seropositive LETM predominantly affected women in contrast to the seronegative ones. The lengths of spinal cord lesions on MRI were positively correlated with the FU values of the AQP-4Ab at the nadir of exacerbations. The FU values of the AQP-4Ab became lower after high-dose methylprednisolone, and a follow-up showed it remained low in the relapse-free periods.3patients presenting with symptoms outside of the optic nerves spinal cord were all seropositive.Conclusions:(1) The data bank was helpful for storage and inquiry of the patient record and designing of clinical research. NMO was different from MS in the aspects of onset age, gender, clinical features, prognosis and MRI image.(2) Detection of AQP-4antibody could help to differentiate NMO from MS with good sensitivity and excellent specificity in CBA, FIPA and FACS, while CBA had a superior sentivivity (87.9%);(3) AQP-4Ab was a specific marker to NMO spectrum diseases;(4) AQP-4Ab was able to be used to monitor disease and evaluate the treatment;(5) Detection of AQP-4antibody could improve the sensitivity of the diagnostic criteria of NMO and avoid misdiagnosis.