Neuromyelitis optica spectrum disorder: pregnancy-related attack and predictive risk factors.
Neuromyelitis optica spectrum disorder: pregnancy-related attack and predictive risk factors.
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视神经脊髓炎谱系疾病：妊娠相关发作和预测危险因素
DOI：
10.1136/jnnp-2020-323982
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发表时间：
2020-11-20
期刊：
影响因子：
--
通讯作者：
Quan C
中科院分区：
文献类型：
--
作者：
Wang L;Zhou L;ZhangBao J;Huang W;Chang X;Lu C;Wang M;Li W;Xia J;Li X;Chen L;Qiu W;Lu J;Zhao C;Quan C
目的探讨妊娠对视神经脊髓炎谱系障碍(NMOSD)患者的影响，找出预测妊娠相关发病的危险因素。方法2015年1月至2019年4月，华山医院收治女性NMOSD患者418例。我们回顾了他们的医疗记录，确定了110例患者136例有信息的妊娠，其中83例水通道蛋白-4抗体(AQP4-ab)阳性，21例髓鞘少突胶质细胞糖蛋白抗体阳性。与怀孕有关的发作被称为DefiNed，即发生在怀孕期间或分娩/流产后1 内的发作。我们比较了怀孕前12个月和怀孕每三个月以及分娩/流产后的年化复发率(ARR)。多因素分析被用来探索涉及的独立危险因素，并生成了预测妊娠相关发作的诺模图。来自其他3个中心的35名女性患者组成了一个外部队列来验证这一诺模图。结果与妊娠前相比，分娩后(p<；0.001)或流产(p=0.019)早期ARR显著升高。预测妊娠相关发病的独立危险因素包括分娩/流产年龄(20-26.5，p=0.018；26.5-33，p=0.001)、水通道蛋白4-抗体滴度(≥1：100，p=0.049)以及孕期和产后治疗不当(p=0.004)。在内部和外部验证中，采用Bootstrap重采样，诺模图的一致性指数分别为0.87和0.77。结论产后早期是NMOSD复发的高危时期。年龄越小、AQP4-ab滴度越高、治疗不当的患者发生妊娠相关疾病的风险越高。
Objectives To investigate the influence of pregnancy on patients with neuromyelitis optica spectrum disorder (NMOSD) and to identify risk factors that predict pregnancy-related attack. Methods From January 2015 to April 2019, 418 female patients with NMOSD were registered at Huashan Hospital. We retrospectively reviewed their medical records and identified 110 patients with 136 informative pregnancies, of whom 83 were aquaporin-4 antibody (AQP4-ab)-positive and 21 were myelin oligodendrocyte glycoprotein-antibody-positive. Pregnancy-related attack was defined as an attack that occurred during pregnancy or within 1 year after delivery/abortion. We compared annualised relapse rate (ARR) during 12 months before pregnancy with that during every trimester of pregnancy and after delivery/abortion. Multivariate analyses were used to explore the independent risk factors involved and a nomogram was generated for the prediction of pregnancy-related attack. Thirty-five female patients from 3 other centres formed an external cohort to validate this nomogram. Results ARR increased significantly during the first trimester after delivery (p<0.001) or abortion (p=0.019) compared with that before pregnancy. Independent risk factors predicting pregnancy-related attack included age at delivery/abortion (20–26.5, p=0.018; 26.5–33, p=0.001), AQP4-ab titre (≥1:100, p=0.049) and inadequate treatment during pregnancy and postpartum period (p=0.004). The concordance index of nomogram was 0.87 and 0.77 using bootstrap resampling in internal and external validation. Conclusions The first trimester post partum is a high-risk period for NMOSD recurrence. Patients with younger age, higher AQP4-ab titre and inadequate treatment are at higher risk for pregnancy-related attack.
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影响因子：
4.8
作者：
Han K;Song K;Choi BW
通讯作者：
Choi BW
DOI：
10.1016/s1474-4422(12)70133-3
发表时间：
2012-06
期刊：
The Lancet. Neurology
影响因子：
--
作者：
Papadopoulos MC;Verkman AS
通讯作者：
Verkman AS
影响因子：
9.9
作者：
Wingerchuk DM;Banwell B;Bennett JL;Cabre P;Carroll W;Chitnis T;de Seze J;Fujihara K;Greenberg B;Jacob A;Jarius S;Lana-Peixoto M;Levy M;Simon JH;Tenembaum S;Traboulsee AL;Waters P;Wellik KE;Weinshenker BG;International Panel for NMO Diagnosis
通讯作者：
International Panel for NMO Diagnosis
影响因子：
9.9
作者：
Klawiter, Eric C.;Bove, Riley;Weinshenker, Brian
通讯作者：
Weinshenker, Brian
影响因子：
5.1
作者：
Kim, S. -H.;Huh, S. -Y.;Kim, H. J.
通讯作者：
Kim, H. J.