MOG antibody prevalence in adult optic neuritis and clinical predictive factors for diagnosis: A Chinese cohort study
MOG antibody prevalence in adult optic neuritis and clinical predictive factors for diagnosis: A Chinese cohort study
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成人视神经炎中 MOG 抗体的患病率及诊断的临床预测因素：一项中国队列研究
DOI：
10.1016/j.msard.2022.104248
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发表时间：
2022
影响因子：
4
通讯作者：
Shihui Wei
中科院分区：
文献类型：
--
作者：
Honglu Song;Mo Yang;Huanfen Zhou;Zhaohui Li;Shihui Wei
由于AQP 4/MOG抗体检测是不可用的，在世界上的一些地区，并经常有延迟获得结果，它是特别重要的是使用临床因素来预测成人视神经炎（ON）的亚型。MethodsThis was a single center retrospective cohort study.ResultsThe final analysis included 249例成人患者在2016年1月至2020年1月首次出现ON发作。其中包括109例（43.8%）AQP 4-ON病例、49例（19.7%）MOG-ON病例和91例（36.5%）血清阴性ON病例。MOG-ON组视盘肿胀（ODS）和双侧受累的比例显著高于其他两个亚组（P=0.029，0.001）。MOG-ON组的随访BCVA最好（P=0.003）。预测成人AQP 4-ON，单侧受累（敏感性0.88，NPV 0.77）是最敏感的预测因子，而神经系统病史（特异性0.96，PPV 0.65）和伴随的其他自身免疫抗体（特异性0.76，PPV 0.65）是最特异的预测因子。使用平行测试“单侧或其他自身免疫抗体”将灵敏度提高到0.95，最佳NPV为0.88。预测成人MOG-ON，最敏感的临床特征是ODS（敏感性0.79，NPV 0.88）和随访VA ≤0.1logMAR（敏感性0.78，NPV 0.92），而最特异的值是既往神经病史或双侧受累，特异性分别为0.92和0.82。当使用“双侧或ODS或复发”、“双侧或ODS或随访VA ≤ 0.1logMAR”和“ODS或随访VA ≤ 0.1logMAR "的平行临床因素以及相应的NPV时，敏感性增加至0.94、0.97和0.97结论MOG-ON的比例（19.7%）低于AQP 4-ON和Seronegative-ON，且MOG-ON预后较好，易合并ODS或双侧受累。使用平行的临床参数提高了诊断成人MOG-ON和AQP 4-ON的灵敏度。
ObjectiveBecause AQP4/MOG antibody testing is not available in some parts of the world and there are often delays in obtaining results, it is particularly important to use clinical factors to predict the subtypes of adult optic neuritis (ON).MethodsThis was a single-center retrospective cohort study.ResultsThe final analysis included 249 adult patients presenting with the first ON attack during January 2016 to January 2020. These included 109 (43.8%) AQP4-ON cases, 49 (19.7%) MOG-ON cases, and 91 (36.5%) Seronegative-ON cases. The proportion of optic disk swelling (ODS) and bilateral involvement in MOG-ON group was significantly higher than in the other two subgroups (P=0.029, 0.001). The MOG-ON group had the best follow-up BCVA (P=0.003). To predict adult AQP4-ON, unilateral involvement (sensitivity 0.88, NPV 0.77) was the most sensitivity predictors, while neurological history (specificity 0.96, PPV 0.65) and concomitant other autoimmune antibodies (specificity 0.76, PPV 0.65) were the most specific predictors. Using the parallel test ‘unilateral or other autoimmune antibodies’ increased sensitivity to 0.95, with an optimal NPV of 0.88. To predict adult MOG-ON, the most sensitive clinical characteristics were ODS (sensitivity 0.79, NPV 0.88), and follow-up VA ≤0.1logMAR (sensitivity 0.78, NPV 0.92), whereas the most specific values were prior neurological history or bilateral involvement, with specificities of 0.92 and 0.82, respectively. The sensitivity increased to 0.94, 0.97, and 0.97 when using the parallel clinical factors of ‘bilateral or ODS or relapse’, ‘bilateral or ODS or follow-up VA ≤0.1logMAR’, and ‘ODS or follow-up VA ≤0.1logMAR’, and the corresponding NPV (0.94, 0.97 vs 0.98).ConclusionThe proportion of MOG-ON (19.7%) was less than that of AQP4-ON and Seronegative-ON. Moreover, MOG-ON had a better prognosis and was more likely to be associated with ODS or bilateral involvement. The use of parallel clinical parameters improved the sensitivity for the diagnosis of adult MOG-ON and AQP4-ON.