Objective To investigate the distribution of serum autoantibodies in patients with neuromyelitis optic related optic neuritis (NMO-ON),and their effect on the disease recurrence and the prognosis of optic function.Methods A retrospective case study was used.A total of 76 patients with NMO-ON in the Chinese People's Liberation Army General Hospital from June 2014 to March 2015,were recruited.All patients had positive serum aquaporin 4 (AQP4) antibodies.The distribution of serum autoantibodies except for AQP4-Ab,including antinuclear antibody(ANA),SSA,SSB,anti-neutrophil cytoplasmic antibody(ANCA),anti-thyroglobulin antibodies(TG) and anti-thyroid peroxidase antibodies(TPO),was analyzed.The visual acuity at the first onset and at the last follow-up was evaluated.The retinal nerve fiber layer thickness(RNFLT) at the last follow-up and the recurrence of ON were also analyzed.The patients were followed-up for at least 24 months.Results Of 76 patients,40 patients(52.6％) were at least one autoantibody positive,and 28 patients(36.8％) had at least two autoantibodies positive.Of 76 patients,14 patients(18.4％) were diagnosed with autoimmune diseases,24 patients(31.6％) were serum ANA positive,and 12 patients(15.8％) were SSA positive.Both SSA and SSB were positive in 5 patients.The mean times of ON in autoantibodies-positive patients was higher than that in autoantibody-negtive patients(2.90 ± 1.29 vs 2.06 ±0.8,P =0.02).The mean times of ON in ANA-positive patients was higher than that in ANA-negative patients(3.08 ± 1.38 vs 2.12 ±0.91,P =0.042).There was no significant difference in the lowest visual acuity of ON at the first onset between autoantibodies-positive patients and autoantibody-negative patients,and between ANA-positive patients and ANA-negative patients.The visual acuity of ANA-positive patients at 3 month after the onset and at the last follow-up were superior to that of ANA-negative patients (P =O.009,P =0.007).Conclusion The proportion of autoantibodies in serum of NMO-ON patients is higher.The NMO-ON patients with autoantibodies positive,especially ANA positive,have higher recurrence rate in the first two years.However,serum ANA-positive may be associated with less impairment of vision.%目的 评估视神经脊髓炎相关视神经炎(NMO-ON)患者血清自身抗体分布情况及其对疾病复发及视功能预后的影响. 方法 采用回顾性病例研究的方法,分析2014-06～2015-03就诊于中国人民解放军总院神经眼科病房的NMO-ON患者76例,所有患者血清水通道蛋白4抗体(AQP4-Ab)均为阳性,分析其首次住院期间除AQP4-Ab以外的其他血清自身抗体检测结果,包括:抗核抗体(ANA)、Ro/Sj(o)gren综合征相关抗原A(SSA)和B(SSB)、抗中心粒细胞胞浆抗体(ANCA)、抗甲状腺球蛋白抗体、抗甲状腺过氧化物酶抗体等.评估视神经炎首次发病视功能及恢复情况,末次随诊视力及视网膜神经纤维层厚度、视神经炎(ON)复发次数.随诊时间最短为24个月. 结果 52.6％(40/76)的患者出现一项及以上自身抗体阳性,36.8％(28/76)二项及以上自身抗体阳性,18.4％ (14/76)的患者确诊合并其他自身免疫疾病.31.6％(24/76)的患者ANA阳性,15.8％ (12/76)的患者SSA阳性,6.6％ (5/76) SSA、SSB均阳性.一项及以上自身抗体阳性者与自身抗体阴性者ON发病次数分别为2.90±1.29和2.06±0.8(P =0.02),ANA阳性者与ANA阴性者的ON发病次数分别为3.08±1.38和2.12±0.91 (P =0.042).ON首次发病低谷视力在自身抗体阳性组与自身抗体阴性组、ANA阳性组与ANA阴性组之间比较差异均无统计学意义.ANA阳性者发病3个月及末次随访视力均优于ANA阴性者(P =0.009,P=0.007). 结论 NMO-ON患者血清中自身抗体分布比例较高,自身抗体特别是ANA阳性患者在发病2年内有相对较高的ON复发率,然而血清ANA阳性可能与相对轻的视力损害相关.
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