儿童抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病急性期视觉诱发电位特点分析

doi:10.12372/jcp.2022.21e1251

摘要/Abstract

摘要： 目的探讨儿童抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病（MOGAD）急性期的视觉诱发电位（VEP）特点。方法回顾性分析2018年5月至2020年2月收治的临床诊断为中枢神经系统特发性炎性脱髓鞘病（CNS-IIDDs）患儿的临床资料,根据血清MOG抗体检测结果以及是否存在视神经炎进行分组,分析不同组间VEP特点。结果 67例CNS-IIDDs患儿中,MOG抗体阳性组29例（43.3%）,15例（51.7%）存在视神经炎;MOG抗体阴性组38例（56.7%）,19例（50.0%）存在视神经炎。对所有患儿双眼分别进行VEP检测,MOG抗体阳性组含58只眼,MOG抗体阴性组含76只眼,共获得了134只眼的VEP结果。非视神经炎组66只眼中,MOG抗体阳性组的VEP异常率（14/28,50.0%）明显高于MOG抗体阴性组（9/38,23.7%）,差异有统计学意义（P<0.05）。视神经炎组68只眼中,MOG抗体阳性组的盲及重度视力损害比例高于MOG抗体阴性组,差异有统计学意义（P<0.05）。在MOG抗体阳性组58只眼中,不同MOG抗体滴度组之间VEP异常率差异有统计学意义（P<0.05）,随着MOG抗体滴度增高,VEP异常率有增高趋势。结论 VEP检查可以较好地发现MOGAD的视神经亚临床病灶。高MOG抗体滴度条件下发生视觉通路损伤的概率可能更高。

关键词: 髓鞘少突胶质细胞糖蛋白, 髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病, 视觉诱发电位, 视神经炎, 儿童

Abstract: Objective To investigate the characteristics of visual evoked potentials (VEP) in children with MOG-IgG associated disorders (MOGAD) in the acute phase.Methods The clinical data of children admitted from May 2018 to February 2020 who were clinically diagnosed with central nervous system idiopathic inflammatory demyelinating diseases (CNS-IIDDs) were retrospectively analyzed. The children were divided into different groups according to the results of serum MOG-antibody detection and whether the optic nerve was involved clinically. The characteristics of VEP between different groups were analyzed.Results Among 67 children with CNS-IIDDS, 29 (43.3%) were in the MOG antibody positive group, and 15 (51.7%) had optic neuritis. There were 38 (56.7%) children in the MOG antibody negative group, and 19 (50.0%) had optic neuritis. The VEP test was examined on both eyes of all children, including 58 eyes in the MOG antibody positive group and 76 eyes in the MOG antibody negative group, obtaining VEP results of 134 eyes in total. Among the 66 eyes in the non-optic neuritis group, the abnormal rate of VEP in the MOG antibody positive group (14/28, 50.0%) was significantly higher than that in the MOG antibody negative group (9/38, 23.7%), and the difference was statistically significant (P<0.05). In the 68 eyes of the optic neuritis group, the proportion of blindness and severe vision impairment in the MOG antibody positive group was higher than that in the MOG antibody seronegative group, and the difference was statistically significant (P<0.05). In 58 eyes of MOG antibody positive group, there was significant difference in the abnormal rate of VEP between groups with different MOG antibody titer (P<0.05). The abnormal rate of VEP increased with the increase of MOG antibody titer.Conclusions VEP can effectively detect subclinical lesions of optic nerve in MOGAD. The probability of visual pathway damage may be higher under the conditions of high MOG antibody titers.

Key words: myelin oligodendrocyte glycoprotein, myelin oligodendrocyte glycoprotein immunoglobulin G associated disorders, visual evoked potential, optic neuritis, child

陈金晓, 孙静, 杨文民, 王小月, 王昕, 杨健. 儿童抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病急性期视觉诱发电位特点分析[J]. 临床儿科杂志, 2022, 40(4): 284-289.

CHEN Jinxiao, SUN Jing, YANG Wenmin, WANG Xiaoyue, WANG Xin, YANG Jian. A preliminary study on characteristics of visual evoked potentials in children with myelin oligodendrocyte glycoprotein immunoglobulin G associated disorders in the acute phase[J]. Journal of Clinical Pediatrics, 2022, 40(4): 284-289.

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组别	眼数	VEP异常	VEP异常表现
组别	眼数	VEP异常	P100波潜伏期延长	P100波潜伏期延长伴波幅下降	P100波波幅下降	P100波缺失
MOG抗体阳性	58	37(63.8)	16(27.6)	7(12.1)	6(10.3)	8(13.8)
MOG抗体阴性	76	37(48.7)	16(21.1)	4(5.3)	13(17.1)	4(5.3)
χ²值		3.04	0.77	1.22	1.24	2.94
P		0.081	0.379	0.269	0.266	0.087

视神经炎组	眼数	VEP异常	VEP异常表现
视神经炎组	眼数	VEP异常	P100波缺失	盲及重度视力损害
MOG抗体阳性	30	23(76.7)	8(26.7)	12(40.0)
MOG抗体阴性	38	28(73.7)	4(10.5)	7(18.4)
χ²值		0.08	2.95	3.99
P		0.778	0.086	0.046

MOG抗体滴度	眼数	VEP异常表现
MOG抗体滴度	眼数	P100波缺失	盲及重度视力损害
1:10	14	2(14.3)	4(28.6)
1:32	10	3(30.0)	6(60.0)
1:100	6	3(50.0)	2(33.3)
P		0.282	0.349