Diagnostic utility of NMO/AQP4-IgG in evaluating CNS inflammatory disease in Thai patients

JOURNAL OF THE NEUROLOGICAL SCIENCES

卷:320

Article

Apiwattanakul, Metha¹  Asawavichienjinda, Thanin²  Pulkes, Teeratorn³  Tantirittisak, Tasanee¹  Hemachudha, Thiravat²  Horta, Erika S.⁵  Jenkins, Sarah M.⁶  Pittock, Sean J.^4,5 

[1] Prasat Neurol Inst, Dept Neurol, Bangkok 10400, Thailand

[2] Chulalongkorn Univ, Dept Neurol, King Chulalongkorn Mem Hosp, Bangkok, Thailand

[3] Mahidol Univ, Dept Neurol, Ramathibodi Hosp, Bangkok 10700, Thailand

[4] Mayo Clin, Coll Med, Dept Neurol, Rochester, MN 55905 USA

[5] Mayo Clin, Coll Med, Dept Lab Med & Pathol, Rochester, MN 55905 USA

[6] Mayo Clin, Coll Med, Dept Biostat, Rochester, MN USA

关键词: Demyelinating disease;    Devic's syndrome;    Autoimmune diseases;    Neuromyelitis optics;    Aquaporin-4;    Autoantibodies;    Multiple sclerosis;    Assays;    Diagnosis;    Sensitivity;   

DOI  :  10.1016/j.jns.2012.07.014

来源: Elsevier

【 摘 要 】

Epidemiological studies in Thailand have reported that inflammatory demyelinating diseases (IDDs) commonly affect the optic nerve and spinal cord. We investigated the diagnostic utility of aquaporin (AQP)-4-IgG testing in 31 consecutive patients evaluated for CNS IDDs in 3 academic Thai hospital neurology clinics between February 2008 and January 2009. Patients were classified into 3 clinical diagnostic groups: Neuromyelitis optica (NMO, n = 10) multiple sclerosis (MS, n = 5) and unclassified IDD (n = 16). All sera were tested blindly by cell binding (Euroimmun) assay (CBA). Sera were also tested by indirect immunofluorescence assay (IFA) and ELISA (RSR/Kronus). After initial screening by CBA. AQP4-IgG was detected in 6 NMO patients (60%); 3 of the 4 seronegative cases were receiving immunosuppressants. AQP4-IgG was detected in 13 unclassified IDD cases (81%), but in no MS cases. Cell binding assay and EUSA were more sensitive than IFA (p = 0.0004). The 81% seropositivity rate in unclassified patients suggests that AQP4 autoimmunity accounts for a significant proportion of Thai CNS inflammatory demyelinating disease, especially those with optic neuritis or transverse myelitis, with or without abnormal brain MRI, in whom a specific diagnosis or clear-cut treatment approach is unclear. (c) 2012 Elsevier B.V. All rights reserved.

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