抗甲状腺抗体阳性的视神经脊髓炎1例并文献复习

doi:10.3969/j.issn.1004-583X.2023.03.013

摘要/Abstract

摘要：

目的探讨抗甲状腺抗体与视神经脊髓炎的发病及预后相关性。方法回顾性分析1例抗甲状腺抗体阳性的视神经脊髓炎患者的临床资料及抗体检测结果, 并复习相关文献。结果患者女,61岁,左侧肢体麻木10 d,加重3 d。脑脊液及血清检测结果提示脑脊液AQP4-IgG 1∶1阳性,血清AQP4-IgG 1∶100阳性。诊断为视神经脊髓炎。结论视神经脊髓炎与甲状腺相关疾病常伴随出现,二者关系仍需更多研究才能得出明确的结论。

关键词: 视神经脊髓炎, 甲状腺疾病, 病例报告

Abstract:

Objective To investigate the correlation between antithyroid antibodies (ATAbs) and neuromyelitis optica (NMO). Methods The clinical data and antibody detection results of one NMO patient with positive ATAbs were retrospectively analyzed, and the related literatures were reviewed. Results The patient, 61 years old female, left limb numbness for 10 days, aggravation for 3 days. The results of cerebrospinal fluid and serum indicated that aquaporin-4 immunoglobulin G (AQP4-IgG)-positive in cerebrospinal fluid and serum was 1∶1 and 1∶100, respectively. The diagnosis was NMO. Conclusion NMO and thyroid-related diseases are often associated, and more studies are needed to draw definite conclusions about their relationship.

Key words: neuromyelitis optica, thyroid disease, case report

中图分类号:

R744.52

王子佳, 王九雪, 王天俊. 抗甲状腺抗体阳性的视神经脊髓炎1例并文献复习[J]. 临床荟萃, 2023, 38(3): 264-267.

Wang Zijia, Wang Jiuxue, Wang Tianjun. One case of neuromyelitis optica with positive antithyroid antibody and literature review[J]. Clinical Focus, 2023, 38(3): 264-267.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.03.013

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I3/264

图/表 1

图1 颈段脊髓矢状面平扫(a)+增强(b)图像显示颈2-7水平脊髓肿胀,颈段脊髓横断面增强(c)+(d)图像显示脊髓内可见条片状T1加权图像稍低、T2加权图像稍高信号影,病变位于脊髓后部,增强扫描呈边缘环形明显强化

Fig. 1 Sagittal plain scan (a)+ enhanced (b) of the cervical spinal cord showed swelling at the cervical 2-7 level.Contrast-enhanced (c)+(d) images of the cervical spinal cord showed a lamina with slightly lower signal intensity on T1 weighted image and slightly higher signal intensity on T2 weighted image. The lesion was located in the posterior part of the spinal cord. Enhanced CT scanning showed an obvious annular enhancement on the edge

参考文献 22

[1]	Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica: Distinction from multiple sclerosis[J]. Lancet, 2004, 364(9451):2106-2112. doi: 10.1016/S0140-6736(04)17551-X pmid: 15589308
[2]	吝娜, 曹磊. 水通道蛋白4在中枢神经系统疾病中的研究进展[J]. 临床荟萃, 2019, 34(6):567-571.
[3]	Jarius S, Aboul-Enein F, Waters P, et al. Antibody to aquaporin-4 in the long-term course of neuromyelitis optica[J]. Brain, 2008, 131(Pt 11):3072-3080. doi: 10.1093/brain/awn240 pmid: 18945724
[4]	Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders[J]. Neurology, 2015, 85(2):177-189. doi: 10.1212/WNL.0000000000001729 pmid: 26092914
[5]	Giannocco G, Kizys M, Maciel RM, et al. Thyroid hormone, gene expression, and central nervous system: Where we are[J]. Semin Cell Dev Biol, 2021, 114:47-56. doi: 10.1016/j.semcdb.2020.09.007 pmid: 32980238
[6]	Scheicht D, Werthmann ML, Zeglam S, et al. Muscle weakness and early stages of liver failure in a 22-year-old man[J]. Internist (Berl), 2013, 54(8):1016-1022. doi: 10.1007/s00108-013-3329-1 pmid: 23900454
[7]	Pittock SJ, Weinshenker BG, Lucchinetti CF, et al. Neuromyelitis optica brain lesions localized at sites of high aquaporin 4 expression[J]. Arch Neurol, 2006, 63(7):964-968.
[8]	Zhang M, Ma Z, Qin H, et al. Thyroid hormone potentially benefits multiple sclerosis via facilitating remyelination[J]. Mol Neurobiol, 2016, 53(7):4406-4416. doi: 10.1007/s12035-015-9375-z pmid: 26243185
[9]	Cho EB, Min JH, Cho HJ, et al. Low T3 syndrome in neuromyelitis optica spectrum disorder: Associations with disease activity and disability[J]. J Neurol Sci, 2016, 370:214-218. doi: S0022-510X(16)30604-9 pmid: 27772762
[10]	He Q, Li L, Li Y, et al. Free thyroxine level is associated with both relapse rate and poor neurofunction in first-attack Neuromyelitis Optica Spectrum Disorder (NMOSD) patients[J]. BMC Neurol, 2019, 19(1):329. doi: 10.1186/s12883-019-1560-7 pmid: 31852443
[11]	Jiang Y, Yang Y, Zhang B, et al. Cerebrospinal fluid levels of iodothyronines and nerve growth factor in patients with multiple sclerosis and neuromyelitis optica[J]. Neuro Endocrinol Lett, 2009, 30(1):85-90.
[12]	Sorensen CM, Hansen TK, Steffensen R, et al. Hormonal regulation of mannan-binding lectin synthesis in hepatocytes[J]. Clin Exp Immunol, 2006, 145(1):173-182. doi: 10.1111/j.1365-2249.2006.03101.x pmid: 16792688
[13]	Zhang B, Jiang Y, Yang Y, et al. Correlation between serum thyroxine and complements in patients with multiple sclerosis and neuromyelitis optica[J]. Neuro Endocrinol Lett, 2008, 29(2):256-260.
[14]	Long Y, Zheng Y, Chen M, et al. Serum thyroid-stimulating hormone and anti-thyroglobulin antibody are independently associated with lesions in spinal cord in central nervous system demyelinating diseases[J]. PLoS One, 2014, 9(8):e100672. doi: 10.1371/journal.pone.0100672 URL
[15]	Li H, Dai Y, Wu A M, et al. Anti-thyroid antibodies and cerebrospinal fluid findings in neuromyelitis optica spectrum disorders[J]. J Neuroimmunol, 2015, 281:38-43. doi: 10.1016/j.jneuroim.2015.02.014 pmid: 25867466
[16]	Wang Y, Zhang L, Zhang B, et al. Comparative clinical characteristics of neuromyelitis optica spectrum disorders with and without medulla oblongata lesions[J]. J Neurol, 2014, 261(5):954-962. doi: 10.1007/s00415-014-7298-7 pmid: 24609971
[17]	张奇山, 雷生锁, 黄仁彬. 伴有自身免疫性甲状腺炎和甲状腺毒血症的视神经脊髓炎1例报告[J]. 中风与神经疾病杂志, 2016, 33(09):842-843.
[18]	Niu D, Kondo T, Nakazawa T, et al. Differential expression of aquaporins and its diagnostic utility in thyroid cancer[J]. PLoS One, 2012, 7(7):e40770. doi: 10.1371/journal.pone.0040770 URL
[19]	Cai G, He D, Chu L, et al. Paraneoplastic neuromyelitis optica spectrum disorders: three new cases and a review of the literature[J]. Int J Neurosci, 2016, 126(7):660-668. doi: 10.3109/00207454.2015.1054481 pmid: 26010208
[20]	Soelberg K, Larsen SR, Moerch MT, et al. Aquaporin-4 IgG autoimmune syndrome and immunoreactivity associated with thyroid cancer[J]. Neurol NeuroimmunolNeuroinflamm, 2016, 3(4):e252.
[21]	Huang Q, Xu Z, Li R, et al. Analysis of clinical characteristics and prognosis of neuromyelitis optic spectrum disease complicated with malignant tumor[J]. Zhonghua Yi Xue Za Zhi, 2018, 98(31):2496-2500.
[22]	Simone L, Pisani F, Mola MG, et al. AQP4 Aggregation state is a determinant for glioma cell fate[J]. Cancer Res, 2019, 79(9):2182-2194. doi: 10.1158/0008-5472.CAN-18-2015 pmid: 30877104