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视神经脊髓炎谱系病(neuromyelitis optica spectrum disorders, NMOSD)是一组主要由抗体介导的细胞膜免疫参与的中枢神经系统(central nervous system, CNS)炎性脱髓鞘疾病,临床特征包括视神经炎(optic neuritis, ON)、长节段横贯性脊髓炎(longitudinally extensive transverse myelitis, LETM)、极后区综合征、急性脑干综合征等核心症状。目前认为包括B、T细胞在内的多种炎性细胞和细胞因子在其发病过程中均起到重要作用。本研究通过分析NMOSD病人外周血清白细胞介素-17(interleukin-17, IL-17)水平及其与临床病情间的关系,进一步探讨IL-17在NMOSD诊断及预后判断中的价值。
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NMOSD组血清IL-17水平为(35.54±10.71)pg/mL,明显高于HCs组(27.03±7.09)pg/mL(t=3.72,P<0.01)。
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NMOSD组EDSS评分为(5.11±2.26)分。血清IL-17水平与EDSS评分呈正相关(r=0.928, P<0.01)(见图 1)。NMOSD组影像学资料显示:LETM 32例,其中累及延髓合并颈髓5例,胸髓8例,颈髓合并胸髓12例,颈胸腰髓均受累1例。Spearman相关性分析显示,血清IL-17水平与脊髓受累节段数呈正相关(r=0.801,P<0.01)(见图 2)。
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统计NMOSD组影像学资料,按磁共振成像有无强化分为强化组21例,血清IL-17水平为(40.24±9.13)pg/mL,高于无强化组15例的(28.97±9.41)pg/mL(t=3.61, P<0.01)。
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NMOSD组血AQP4-Ab阳性27例,其血清IL-17水平(34.24±10.53) pg/mL;血AQP4-Ab阴性9例,其血清IL-17水平(39.44±10.92) pg/mL;两者差异无统计学意义(t=1.27, P>0.05)。NMOSD血清IL-17水平与AQP4-Ab抗体阳性与否无显著相关性(t=1.27, P>0.05)。
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以病人血清IL-17水平为因变量,以EDSS评分、病灶强化与否、脊髓受累节段数为自变量,行多元线性回归分析。结果显示,NMOSD病人血清IL-17水平与EDSS评分、病灶强化与否、脊髓受累节段数存在线性关系(R=0.930,R2=0.866,DW=1.513,F=47.27,P<0.01)。EDSS评分、脊髓受累节段数对血清IL-17水平有明显影响(P<0.01和P<0.05),而病灶强化与否对血清IL-17水平有影响趋势(P>0.05)(见表 1)。
变量 B Waldχ2 B′ t P EDSS评分 2.89 0.54 0.65 5.40 <0.01 受累脊髓节段数 1.58 0.58 0.33 0.33 <0.05 病灶是否强化 2.46 1.68 0.12 1.46 >0.05 表 1 NMOSD病人血清IL-17水平的多因素logistics回归分析
血清白细胞介素-17与视神经脊髓炎谱系疾病的关系
Study on the relationship between the serum level of interleukin-17 and neuromyelitis spectrum diseases
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摘要:
目的研究视神经脊髓炎谱系疾病(NMOSD)血清中白细胞介素17(IL-17)在发病中的意义及其与疾病严重程度的相关性。 方法酶联免疫吸附法检测36例NMOSD急性期病人(NMOSD组)与30名健康志愿者(HCs组)血清IL-17;对NMOSD组血清IL-17水平与扩展残疾状况评分(EDSS)、脊髓受累节段数、病灶是否增强及水通道蛋白4抗体(AQP4-Ab)滴度等临床指标的相关性进行分析。 结果NMOSD组血清IL-17水平为(35.54±10.71),较HCs组(HCs)(27.03±7.09)明显升高(P<0.001)。NMOSD组血清IL-17水平与EDSS评分、脊髓受累节段数呈正相关(P<0.01),病灶有强化者血清IL-17水平较病灶无强化者明显升高(P<0.01),AQP4-Ab对血清IL-17水平无影响(P>0.05)。多元回归分析显示血清IL-17水平与EDSS评分、脊髓受累节段数存在正相关性(P<0.01和P<0.05)。 结论IL-17可能参与了NMOSD的发病过程,与疾病严重程度相关,可以作为病情判断及疾病潜在进展的预测指标之一。 Abstract:ObjectiveTo investigate the significance of serum the level of interleukin-17(IL-17) in the neuromyelitis optica Spectrum disorders(NMOSD), and its correlation with disease severity. MethodsThe serum concentrations of IL-17 in 36 patients with NMOSD(NMOSD group) and 30 healthy volunteers(HCs group) were measured using enzyme-linked immunosorbent assay(ELISA).The correlations between serum level of IL-17 and extended disability score(EDSS), number of spinal cord involved segments, enhancement of lesion and titer of aquaphosin 4 antibody(AQP4-Ab) were analyzed in NMOSD group. ResultsThe serum level of IL-17 in NMOSD group(35.54±10.71) was significantly higher than in HCs group(27.03±7.09)(P < 0.01).The serum level of IL-17 in NMOSD group was positive correlation with EDSS score and number of spinal cord involved segments(P < 0.01), the serum level of IL-17 in patients with enhancement of lesion significantly increased compared with patients without enhancement of lesion(P < 0.01), and there was not significant correlation between IL-17 level and antibody titers of AQP4-Ab(P>0.05).The results of multivariate regression analysis showed that the serum level of IL-17 were positively correlated with EDSS score and number of spinal cord lesion(P < 0.01 and P < 0.05). ConclusionsThe IL-17 may participate in the pathogenic process of NMOSD, and can be used as one of the predictors in judging disease and potential progression of disease. -
表 1 NMOSD病人血清IL-17水平的多因素logistics回归分析
变量 B Waldχ2 B′ t P EDSS评分 2.89 0.54 0.65 5.40 <0.01 受累脊髓节段数 1.58 0.58 0.33 0.33 <0.05 病灶是否强化 2.46 1.68 0.12 1.46 >0.05 -
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