Glial fibrillary acidic protein immunoglobulin G‑associated myelitis：Clinical features and comparison with aquaporin‑4 immunoglobulin G‑associated myelitis and myelin oligodendrocyte glycoprotein immunoglobulin G‑associated myelitis
10.19845/j.cnki.zfysjjbzz.2026.0061
- VernacularTitle:GFAP-IgG相关脊髓炎：临床特征及其与AQP4-IgG和MOG-IgG相关脊髓炎的比较研究
- Author:
Xinru ZHOU
1
;
Nanchang XIE
1
Author Information
1. Department of Neurology， The First Affiliated Hospital of Zhengzhou University， Zhengzhou 450052， China
- Publication Type:Journal Article
- Keywords:
Glial fibrillary acidic protein immunoglobulin G;
Aquaporin-4 immunoglobulin G;
Myelin oligodendrocyte glycoprotein immunoglobulin G;
Myelitis;
Comparison
- MeSH:
Myelitis
- From:
Journal of Apoplexy and Nervous Diseases
2026;43(4):356-362
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical features of glial fibrillary acidic protein immunoglobulin G （GFAP-IgG）-associated myelitis， to compare the differences in clinical features between GFAP-IgG-associated myelitis and aquaporin-4 immunoglobulin G （AQP4-IgG）-associated myelitis/myelin oligodendrocyte glycoprotein immunoglobulin G （MOG-IgG）-associated myelitis， and to provide help for early diagnosis and treatment. Methods A retrospective analysis was performed for the clinical data of 34 patients who were diagnosed with GFAP-IgG-associated myelitis in The First Affiliated Hospital of Zhengzhou University and Henan Children Hospital from May 2018 to May 2023， and their demographic features， clinical features， serological parameters，cerebrospinal fluid （CSF） parameters， imaging features， and prognosis were systematically analyzed. In addition， 30 patients diagnosed with AQP4-IgG-associated myelitis and 42 patients diagnosed with MOG-IgG-associated myelitis during the same period of time were enrolled as control groups， and the mean clinical features were compared between the three groups. Results Among the 34 patients with GFAP-IgG-associated myelitis， there were 15 female patients and 12 children. The median age of onset was 28.5 years， and more than half of the patients had prodromal symptoms. More than half of the patients had the symptoms of pyrexia （29/34， 85%）， headache （19/34，56%）， nausea/vomiting （20/34，59%），and limb weakness （27/34，79%） during the course of the disease， with 19 patients（19/34，56%） admitted to the intensive care unit （ICU）.Imaging examination showed gadolinium-enhancing spinal cord lesions and longitudinally extensive sagittal T2 hyperintensity， i.e.，longitudinally extensive transverse myelitis.Compared with the AQP4-IgG-associated myelitis group and the MOG-IgG-associated myelitis group，the GFAP-IgG-associated myelitis group had a significantly higher proportion of patients with pyrexia （85% vs 10%， P1<0.01； 85% vs 38%，P2<0.01）， neck stiffness （41% vs 7%， P1<0.01； 41% vs 12%， P2<0.01）， admission to the ICU （56% vs 10%， P1<0.01； 56% vs 17%， P2<0.01）， or mechanical ventilation （38% vs 3%， P1<0.01； 38% vs 0%， P2<0.01） and a significant increase in serum monocyte-to-lymphocyte ratio [0.43（0.24，0.71） vs 0.23 （0.18，0.32）， P1<0.01； 0.43 （0.24，0.71） vs 0.21 （0.14，0.30），P2<0.01]， as well as a significantly higher proportion of patients with hyponatremia （45% vs 13%，P1<0.01； 45% vs 7%，P2<0.01）， an increase in leukocyte count in CSF（68% vs 14%， P1<0.01； 68% vs 34%， P2<0.01）， an increase in total protein in CSF （82% vs 31%， P1<0.01； 82% vs 20%， P2<0.01）， a reduction in glucose level in CSF （26% vs 3%，P1=0.03； 26% vs 2%， P2<0.01）， or the presence of central canal enhancement （29% vs 0%， P1=0.02；29% vs 0%， P2=0.01）. Compared with the AQP4-IgG-associated myelitis group， the GFAP-IgG-associated myelitis group had a significantly higher number of the diseased segments of spinal cord [13（5.8，18） vs 6（3，12.5），P=0.01]. Compared with the MOG-IgG-associated myelitis group， the GFAP-IgG-associated myelitis group had a significantly higher EDSS score at discharge [4（3，6） vs 1（0，3），P2=0.01] and at last follow-up [0（0，2.8） vs 0（0，1），P2=0.047]. Conclusion There are differences in clinical features， serological/CSF profiles， and imaging features among the three groups of patients with myelitis，which may help with the differential diagnosis of the different subtypes of myelitis.
- Full text:2026061214444284328GFAP-IgG相关脊髓炎：临床特征及其与AQP4-IgG和MOG-IgG相关脊髓炎的比较研究.pdf
