背景:视神经脊髓炎(NMO)是一种自身免疫性炎症性疾病,其特征是视神经炎和脊髓炎的严重发作。水通道蛋白-4(AQP4)(或NMO-IgG)的抗体(Ab)作为NMO的血清学生物标志物已被广泛使用。然而,部分NMO患者保持AQP4-Ab血清阴性和/或未检测到视神经受累.此外,在NMO中,AQP4-Ab血清状态与视觉结局之间的关联未达成共识.为了更准确地估计这种假设关系,基于现有的相关研究进行了荟萃分析.
方法:PubMed和MEDLINE检索了截至2016年3月的研究。评估研究质量,使用RevMan5.1进行荟萃分析。计算95%置信区间的赔率比,并应用漏斗图来评估潜在的发表偏倚。
结果:在总共1288项相关研究中,18项研究符合资格标准,并被纳入系统审查。只有9项研究符合荟萃分析的条件,包括624例AQP4-Ab阳性和119例AQP4-Ab阴性NMO患者。结果显示AQP4-Ab血清阳性与NMO视力损害之间存在关联(OR,3.16;95%CI,1.09,9.19;P=0.03)。基于不同AQP-4检测方法的亚组分析结果也显示NMO中AQP4-Ab血清阳性和视力损害之间存在显着差异。尤其是在CBA亚组。
结论:这项荟萃分析表明,AQP4-Ab血清状态呈阳性,NMO的视觉结果较差。
Backgroud: Neuromyelitis optica (NMO) is an autoimmune inflammatory disorder, which is characterized by severe attacks of optic neuritis and myelitis. Antibodies (Ab) to aquaporin-4 (AQP4) (or NMO-IgG) as a serological biomarker of NMO have been widespread used. Nevertheless, some NMO patients remain seronegative for AQP4-Ab and/or have no detected optic nerve involvement. In addition, no consensus exists on the association between AQP4-Ab
serostatus and visual outcome in NMO. To drive a more precise estimate of this postulated relationship, a metaanalysis was performed based on existing relevant studies.
METHODS: Studies were searched by PubMed and MEDLINE up to March 2016. Study quality was assessed, and meta-analysis was conducted using the RevMan 5.1. Odds ratios with 95% confidence interval were calculated and funnel plot was applied to assess the potential publication bias.
RESULTS: In a total of 1288 relevant studies, 18 studies satisfied the eligibility criteria and were included in the systemic
review. Only 9 studies appeared eligible for the meta-analysis, together including 624 AQP4-Ab-positive and 119 AQP4-Ab-negative NMO patients. The results revealed associations between AQP4-Ab seropositivity and visual impairment in NMO (OR, 3.16; 95% CI, 1.09, 9.19; P = 0.03). The results of subgroup analyses based on different methods of AQP-4 detection also showed significantly differences between AQP4-Ab seropositivity and visual impairment in NMO, especially in CBA subgroup.
CONCLUSIONS: This meta-analysis indicates that AQP4-Ab
serostatus has the positive with poor visual outcome in NMO.