目的:临床上出现髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)的患者,如急性播散性脑脊髓炎(ADEM),视神经炎(ON),横贯性脊髓炎(TM)或水通道蛋白-4-IgG(AQP4-IgG)阴性视神经脊髓炎谱系障碍(NMOSD)样表型。我们旨在分析和比较MOGAD儿童的血液参数,AQP4-IgG阳性NMOSD(因此NMOSD),多发性硬化症(MS)和健康对照(HC)。
方法:我们评估了全血计数(CBC)的差异,中性粒细胞与淋巴细胞比率(NLR),血小板与淋巴细胞比率(PLR),这四组之间以及临床发作之间的组中的单核细胞与淋巴细胞比率(MLR)和C反应蛋白(CRP),急性治疗和缓解。
结果:我们的队列包括174名儿童和青少年,共550个时间点:66名患者患有MOGAD(202个时间点),11NMOSD(76个时间点),58MS(219个时间点)和39个是HC(53个时间点)。在临床发作时,与缓解组相比(p<0.001)和与所有其他组相比(p<0.001),MOGAD中的白细胞计数升高。NLR在MOGAD和NMOSD中很高,NMOSD的PLR很高,然而,在对多重检验进行校正后,这些发现没有显著性.糖皮质激素引起NMOSD和MS中白细胞计数和NLR的增加,这些值在MOGAD急性治疗期间保持稳定.在缓解期,NLR在MOGAD中归一化,而它在NMOSD中保持较高。NMOSD的PLR增加,与所有其他组相比明显更高。
结论:一些血液参数,主要是白细胞和分类计数,可以帮助临床医生评估疾病活动,区分复发和假复发,甚至区分不同的疾病实体。
OBJECTIVE: Patients with myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD) clinically present e.g. with acute disseminated encephalomyelitis (ADEM), optic neuritis (ON), transverse myelitis (TM) or aquaporin-4-IgG (AQP4-IgG) negative neuromyelitis optica spectrum disorders (NMOSD)-like phenotypes. We aimed to analyze and compare blood parameters in children with MOGAD, AQP4-IgG-positive NMOSD (hence NMOSD), multiple sclerosis (MS) and healthy controls (HC).
METHODS: We evaluated differences in complete blood counts (CBC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and C-reactive protein (CRP) between these four groups and within the groups between clinical attack, acute treatment and remission.
RESULTS: Our cohort consisted of 174 children and adolescents with a total of 550 timepoints: 66 patients had MOGAD (202 timepoints), 11 NMOSD (76 timepoints), 58 MS (219 timepoints) and 39 were HC (53 timepoints). At clinical attack, leukocyte counts were elevated in MOGAD compared to remission (p < 0.001) and compared to all other groups (p < 0.001). NLR was high in MOGAD and NMOSD, and PLR was high in NMOSD, however, after correction for multiple testing these findings did not remain significant. While glucocorticoids caused an increase of leukocyte counts and NLR in NMOSD and MS, these values remained stable during acute treatment in MOGAD. In remission, NLR normalized in MOGAD, while it stayed high in NMOSD. PLR increased in NMOSD and was significantly higher compared to all other groups.
CONCLUSIONS: Some blood parameters, mainly leukocyte and differential counts, might help clinicians to evaluate disease activity, differentiate relapses from pseudo-relapses and even distinguish between different disease entities.