视神经脊髓炎谱系疾病与妊娠

doi:10.3969/j.issn.1672-6731.2022.01.005

摘要/Abstract

摘要： 视神经脊髓炎谱系疾病是一种中枢神经系统自身免疫性疾病，好发于育龄期女性，可影响妊娠计划、生育能力，对妊娠结局的影响尚不明确；妊娠可引起免疫系统和性激素水平变化，造成疾病复发和进展。合理的免疫抑制治疗可以有效避免妊娠相关疾病活动。妊娠期和分娩后应用小剂量糖皮质激素、硫唑嘌呤和利妥昔单抗可能是安全的。

关键词: 视神经脊髓炎, 妊娠, 女性, 综述

Abstract: Neuromyelitis optica spectrum diseases (NMOSDs) is an autoimmune disease of central nervous system, which occurs frequently in women of childbearing age. NMOSDs may affect pregnancy planning and fertility, and the effect on pregnancy outcome is not clear. Pregnancy can cause changes in the immune system and sex hormone levels, which results in NMOSDs recurrence and progression. Reasonable immunosuppressive treatment may effectively avoid pregnancy - related disease activities using low-dose corticosteroids, azathioprine and rituximab may be safe during pregnancy and after delivery.

Key words: Neuromyelitis optica, Pregnancy, Femininity, Review

刘强, 张庆, 全超. 视神经脊髓炎谱系疾病与妊娠[J]. 中国现代神经疾病杂志, 2022, 22(1): 31-37.

LIU Qiang, ZHANG Qing, QUAN Chao. Neuromyelitis optica spectrum disorders and pregnancy[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2022, 22(1): 31-37.

https://journal11.magtechjournal.com/cjcnn/CN/Y2022/V22/I1/31

参考文献

[1] Hor JY, Asgari N, Nakashima I, Broadley SA, Leite MI, Kissani N, Jacob A, Marignier R, Weinshenker BG, Paul F, Pittock SJ, Palace J, Wingerchuk DM, Behne JM, Yeaman MR, Fujihara K. Epidemiology of neuromyelitis optica spectrum disorder and its prevalence and incidence worldwide [J]. Front Neurol, 2020, 11: 501.
[2] Papp V, Magyari M, Aktas O, Berger T, Broadley SA, Cabre P, Jacob A, Kira JI, Leite MI, Marignier R, Miyamoto K, Palace J, Saiz A, Sepulveda M, Sveinsson O, Illes Z. Worldwide incidence and prevalence of neuromyelitis optica: a systematic review[J]. Neurology, 2021, 96: 59-77.
[3] Holroyd KB, Manzano GS, Levy M. Update on neuromyelitis optica spectrum disorder[J]. Curr Opin Ophthalmol, 2020, 31: 462-468.
[4] Sadeghpour N, Mirmosayyeb O, Bjørklund G, Shaygannejad V. Is fertility affected in women of childbearing age with multiple sclerosis or neuromyelitis optica spectrum disorder[J]? J Mol Neurosci, 2020, 70: 1829-1835.
[5] Chang VTW, Chang HM. Review: recent advances in the understanding of the pathophysiology of neuromyelitis optica spectrum disorder[J]. Neuropathol Appl Neurobiol, 2020, 46: 199-218.
[6] Gold SM, Willing A, Leypoldt F, Paul F, Friese MA. Sex differences in autoimmune disorders of the central nervous system[J]. Semin Immunopathol, 2019, 41: 177-188.
[7] Tian DC, Li Z, Yuan M, Zhang C, Gu H, Wang Y, Shi FD. Incidence of neuromyelitis optica spectrum disorder (NMOSD) in China: a national population - based study[J]. Lancet Reg Health West Pac, 2020, 2: 100021.
[8] Huang W, ZhangBao J, Chang X, Wang L, Zhao C, Lu J, Wang M, Ding X, Xu Y, Zhou L, Li D, Behne MK, Behne JM, Yeaman MR, Katz E, Lu C, Quan C; Guthy - Jackson Charitable Foundation International Clinical Consortium (GJCF-ICC). Neuromyelitis optica spectrum disorder in China: quality of life and medical care experience [J]. Mult Scler Relat Disord, 2020, 46: 102542.
[9] Vandebroek A, Yasui M. Regulation of AQP4 in the central nervous system[J]. Int J Mol Sci, 2020, 21: 1603.
[10] Altintas A, Dargvainiene J, Schneider - Gold C, Asgari N, Ayzenberg I, Ciplea AI, Junker R, Leypoldt F, Wandinger KP, Hellwig K. Gender issues of antibody - mediated diseases in neurology: NMOSD/autoimmune encephalitis/MG[J]. Ther Adv Neurol Disord, 2020, 13: 1756286420949808.
[11] Sun XL, Ding JH, Fan Y, Zhang J, Gao L, Hu G. Aquaporin 4 regulates the effects of ovarian hormones on monoamine neurotransmission[J]. Biochem Biophys Res Commun, 2007, 353: 457-462.
[12] Sun XL, Zhang J, Fan Y, Ding JH, Sha JH, Hu G. Aquaporin-4 deficiency induces subfertility in female mice[J]. Fertil Steril, 2009, 92: 1736-1743.
[13] Bove R, Elsone L, Alvarez E, Borisow N, Cortez MM, Mateen FJ, Mealy MA, Mutch K, Tobyne S, Ruprecht K, Buckle G, Levy M, Wingerchuk DM, Paul F, Cross AH, Weinshenker B, Jacob A, Klawiter EC, Chitnis T. Female hormonal exposures and neuromyelitis optica symptom onset in a multicenter study [J]. Neurol Neuroimmunol Neuroinflamm, 2017, 4: e339.
[14] Ashtari F, Mehdipour R, Shaygannejad V, Asgari N. Pre - pregnancy, obstetric and delivery status in women with neuromyelitis optica spectrum disorder[J]. Mult Scler Relat Disord, 2020, 44: 102252.
[15] Rosito S, Nicchia GP, Palazzo C, Lia A, Buccoliero C, Pisani F, Svelto M, Trojano M, Frigeri A. Supramolecular aggregation of aquaporin - 4 is different in muscle and brain: correlation with tissue susceptibility in neuromyelitis optica[J]. J Cell Mol Med, 2018, 22: 1236-1246.
[16] Chihara N. At the dawn of personalised medicine in neuromyelitis optica spectrum disorder: the impact of the disease activity on pregnancy [J]. J Neurol Neurosurg Psychiatry, 2020. [Epub ahead of print]
[17] Nour MM, Nakashima I, Coutinho E, Woodhall M, Sousa F, Revis J, Takai Y, George J, Kitley J, Santos ME, Nour JM, Cheng F, Kuroda H, Misu T, Martins - da - Silva A, DeLuca GC, Vincent A, Palace J, Waters P, Fujihara K, Leite MI. Pregnancy outcomes in aquaporin-4-positive neuromyelitis optica spectrum disorder [J]. Neurology, 2016, 86: 79-87.
[18] Kim SH, Huh SY, Jang H, Park NY, Kim Y, Jung JY, Lee MY, Hyun JW, Kim HJ. Outcome of pregnancies after onset of the neuromyelitis optica spectrum disorder[J]. Eur J Neurol, 2020, 27: 1546-1555.
[19] Wang L, Zhou L, ZhangBao J, Huang W, Chang X, Lu C, Wang M, Li W, Xia J, Li X, Chen L, Qiu W, Lu J, Zhao C, Quan C. Neuromyelitis optica spectrum disorder: pregnancy - related attack and predictive risk factors[J]. J Neurol Neurosurg Psychiatry, 2020, 92: 53-61.
[20] Salvador NRS, Brito MNG, Alvarenga MP, Alvarenga RMP. Neuromyelitis optica and pregnancy - puerperal cycle[J]. Mult Scler Relat Disord, 2019, 34: 59-62.
[21] Tong Y, Liu J, Yang T, Kang Y, Wang J, Zhao T, Cheng C, Fan Y. Influences of pregnancy on neuromyelitis optica spectrum disorders and multiple sclerosis[J]. Mult Scler Relat Disord, 2018, 25: 61-65. sis[J
[22] Collongues N, Alves Do Rego C, Bourre B, Biotti D, Marignier R, da Silva AM, Santos E, Maillart E, Papeix C, Palace J, Leite MIS, De Seze J. Pregnancy in patients with AQP4 - Ab, MOG - Ab, or double - negative neuromyelitis optica disorder[J]. Neurology, 2021, 96: e2006-2015.
[23] Brummelte S, Galea LA. Postpartum depression: etiology, treatment and consequences for maternal care[J]. Horm Behav, 2016, 77: 153-166.
[24] Qiu K, He Q, Chen X, Liu H, Deng S, Lu W. Pregnancy-related immune changes and demyelinating diseases of the central nervous system[J]. Front Neurol, 2019, 10: 1070.
[25] Wang P, Jiang G, Ju W, Cai Y, Wang J, Wu F. Influence of bushen tiaochong cycle therapy on Th1/Th2 deviation, sex hormone level, and pregnancy outcome of alloimmune recurrent spontaneous abortion[J]. Evid Based Complement Alternat Med, 2021: ID8624414.
[26] Gao M, Yao X, Ding J, Hong R, Wu Y, Huang H, Zhuang L, Li Z, Wang Y, Zhang Y, Guan Y. Low levels of vitamin D and the relationship between vitamin D and Th2 axis - related cytokines in neuromyelitis optica spectrum disorders[J]. J Clin Neurosci, 2019, 61: 22-27.
[27] Zhang Y, Yao XY, Gao MC, Ding J, Hong RH, Huang H, Zhuang L, Wang YG, Hao Y, Guan YT. Th2 axis - related cytokines in patients with neuromyelitis optica spectrum disorders [J]. CNS Neurosci Ther, 2018, 24: 64-69.
[28] Wuebbolt D, Nguyen V, D'Souza R, Wyne A. Devic syndrome and pregnancy: a case series [J]. Obstet Med, 2018, 11: 171-177.
[29] Ruedy J. Teratogenic risk of drugs used in early pregnancy[J]. Can Fam Physician, 1984, 30: 2133-2136.
[30] Bay Bjørn AM, Ehrenstein V, Hundborg HH, Nohr EA, Sørensen HT, Nørgaard M. Use of corticosteroids in early pregnancy is not associated with risk of oral clefts and other congenital malformations in offspring[J]. Am J Ther, 2014, 21: 73-80.
[31] Kaplan TB. Management of demyelinating disorders in pregnancy [J]. Neurol Clin, 2019, 37: 17-30.
[32] Daouda MT, Obenda NS, Assadeck H, Camara D, Djibo FH. A treatment of neuromyelitis optica (Devic's disease) during pregnancy [J]. Pan Afr Med J, 2016, 24: 230.
[33] Matsumoto Y, Tsuchiya M, Norshalena S, Kaneko C, Kubo J, Yamamoto T, Takahashi T, Fujihara K. Severe aquaporin 4-IgG- positive neuromyelitis optica with disseminated herpes zoster in a pregnant woman successfully treated with intravenous immunoglobulin[J]. Mult Scler J Exp Transl Clin, 2018, 4: 2055217318758119.
[34] Munger KC, Samkoff LM. Initiation of rituximab therapy for new onset neuromyelitis optica spectrum disorder during pregnancy[J]. Mult Scler Relat Disord, 2020, 37: 101442.
[35] Gómez - Figueroa E, Alvarado - Bolaños A, García - Estrada C, Zabala - Ángeles I, Sánchez - Rosales N, Bribiesca - Contreras E, García - Alvarez G, Montes - Pérez Y, Ramos - Vega E, Casallas - Vanegas A, Carrillo - Loza K, Corona - Vázquez T, Rivas - Alonso V, Flores - Rivera J. Clinical experience of plasmapheresis for neuromyelitis optica patients in Mexico[J]. Mult Scler Relat Disord, 2021, 52: 103022.
[36] Han M, Chen Y, Nong L, Liu Z, Hao L, Wang Z. Safety and efficacy of plasma exchange for the treatment of optic neuritis in neuromyelitis optica spectrum disorders: a protocol for systematic review and meta - analysis[J]. Medicine (Baltimore), 2020, 99: e21067.
[37] Wind M, Gaasbeek AGA, Oosten LEM, Rabelink TJ, van Lith JMM, Sueters M, Teng YKO. Therapeutic plasma exchange in pregnancy: a literature review[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 260: 29-36.
[38] D'Souza R, Wuebbolt D, Andrejevic K, Ashraf R, Nguyen V, Zaffar N, Rotstein D, Wyne A. Pregnancy and neuromyelitis optica spectrum disorder - reciprocal effects and practical recommendations: a systematic review[J]. Front Neurol, 2020, 11: 544434.
[39] Poupart J, Giovannelli J, Deschamps R, Audoin B, Ciron J, Maillart E, Papeix C, Collongues N, Bourre B, Cohen M, Wiertlewski S, Outteryck O, Laplaud D, Vukusic S, Marignier R, Zephir H; NOMADMUS Study Group. Evaluation of efficacy and tolerability of first-line therapies in NMOSD[J]. Neurology, 2020, 94: e1645-1656.
[40] Aungsumart S, Apiwattanakul M. Cost effectiveness of rituximab and mycophenolate mofetil for neuromyelitis optica spectrum disorder in Thailand: economic evaluation and budget impact analysis [J]. PLoS One, 2020, 15: e0229028.
[41] Kunchok A, Malpas C, Nytrova P, Havrdova EK, Alroughani R, Terzi M, Yamout B, Hor JY, Karabudak R, Boz C, Ozakbas S, Olascoaga J, Simo M, Granella F, Patti F, McCombe P, Csepany T, Singhal B, Bergamaschi R, Fragoso Y, Al-Harbi T, Turkoglu R, Lechner-Scott J, Laureys G, Oreja-Guevara C, Pucci E, Sola P, Ferraro D, Altintas A, Soysal A, Vucic S, Grand'Maison F, Izquierdo G, Eichau S, Lugaresi A, Onofrj M, Trojano M, Marriott M, Butzkueven H, Kister I, Kalincik T. Clinical and therapeutic predictors of disease outcomes in AQP4 - IgG+ neuromyelitis optica spectrum disorder[J]. Mult Scler Relat Disord, 2020, 38: 101868.
[42] Bandoli G, Palmsten K, Forbess Smith CJ, Chambers CD. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes[J]. Rheum Dis Clin North Am, 2017, 43: 489-502.
[43] Götestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer - Betz R, Elefant E, Chambers C, da Silva J, Nelson-Piercy C, Cetin I, Costedoat - Chalumeau N, Dolhain R, Förger F, Khamashta M, Ruiz - Irastorza G, Zink A, Vencovsky J, Cutolo M, Caeyers N, Zumbühl C, Østensen M. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation[J]. Ann Rheum Dis, 2016, 75: 795-810.
[44] Ciplea AI, Langer - Gould A, de Vries A, Schaap T, Thiel S, Ringelstein M, Gold R, Hellwig K. Monoclonal antibody treatment during pregnancy and/or lactation in women with MS or neuromyelitis optica spectrum disorder [J]. Neurol Neuroimmunol Neuroinflamm, 2020, 7: e723.
[45] Kümpfel T, Thiel S, Meinl I, Ciplea AI, Bayas A, Hoffmann F, Hofstadt-van Oy U, Hoshi M, Kluge J, Ringelstein M, Aktas O, Stoppe M, Walter A, Weber MS, Ayzenberg I, Hellwig K. Anti- CD20 therapies and pregnancy in neuroimmunologic disorders: a cohort study from Germany [J]. Neurol Neuroimmunol Neuroinflamm, 2020, 8: e913.
[46] Das G, Damotte V, Gelfand JM, Bevan C, Cree BAC, Do L, Green AJ, Hauser SL, Bove R. Rituximab before and during pregnancy: a systematic review, and a case series in MS and NMOSD[J]. Neurol Neuroimmunol Neuroinflamm, 2018, 5: e453.
[47] Reich DS, Lucchinetti CF, Calabresi PA. Multiple sclerosis[J]. N Engl J Med, 2018, 378: 169-180.
[48] Traboulsee A, Greenberg BM, Bennett JL, Szczechowski L, Fox E, Shkrobot S, Yamamura T, Terada Y, Kawata Y, Wright P, Gianella - Borradori A, Garren H, Weinshenker BG. Safety and efficacy of satralizumab monotherapy in neuromyelitis optica spectrum disorder: a randomised, double - blind, multicentre, placebo - controlled phase 3 trial[J]. Lancet Neurol, 2020, 19: 402-412.
[49] Pittock SJ, Berthele A, Fujihara K, Kim HJ, Levy M, Palace J, Nakashima I, Terzi M, Totolyan N, Viswanathan S, Wang KC, Pace A, Fujita KP, Armstrong R, Wingerchuk DM. Eculizumab in aquaporin - 4 - positive neuromyelitis optica spectrum disorder [J]. N Engl J Med, 2019, 381: 614-625.
[50] Holmøy T, Høglund RA, Illes Z, Myhr KM, Torkildsen Ø. Recent progress in maintenance treatment of neuromyelitis optica spectrum disorder [J]. J Neurol, 2021, 268: 4522-4536.
[51] Cree BAC, Bennett JL, Kim HJ, Weinshenker BG, Pittock SJ, Wingerchuk DM, Fujihara K, Paul F, Cutter GR, Marignier R, Green AJ, Aktas O, Hartung HP, Lublin FD, Drappa J, Barron G, Madani S, Ratchford JN, She D, Cimbora D, Katz E; N - MOmentum Study Investigators. Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N - MOmentum): a double-blind, randomised placebo-controlled phase 2/3 trial[J]. Lancet, 2019, 394: 1352-1363.
[52] Nakagawa K, Kwak - Kim J, Hisano M, Kasahara Y, Kuroda K, Sugiyama R, Yamaguchi K. Obstetric and perinatal outcome of the women with repeated implantation failures or recurrent pregnancy losses who received pre - and post - conception tacrolimus treatment[J]. Am J Reprod Immunol, 2019, 82: e13142.
[53] Xia SX, Miao YL. Analysis of pregnancy and inflammation bowel disease[J]. Zhongguo Fu You Bao Jian, 2014, 29: 1142-1144. 夏蜀娴, 缪应雷. 妊娠与炎症性肠病分析[J]. 中国妇幼保健, 2014, 29: 1142-1144.
[54] Birru Talabi M, Clowse MEB. Antirheumatic medications in pregnancy and breastfeeding[J]. Curr Opin Rheumatol, 2020, 32: 238-246.
[55] Shosha E, Pittock SJ, Flanagan E, Weinshenker BG. Neuromyelitis optica spectrum disorders and pregnancy: interactions and management [J]. Mult Scler, 2017, 23: 1808-1817.
[56] Langer - Gould AM. Pregnancy and family planning in multiple sclerosis [J]. Continuum (Minneap Minn), 2019, 25: 773-792.

选择文件类型/文献管理软件名称

选择包含的内容

2 视神经脊髓炎谱系疾病与妊娠

Neuromyelitis optica spectrum disorders and pregnancy

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	佟志勇. 颅内动脉瘤与脑血管重建术[J]. 中国现代神经疾病杂志, 2024, 24(8): 595-598.
[2]	佟志勇. 脑血管重建术历史沿革[J]. 中国现代神经疾病杂志, 2024, 24(8): 599-605.
[3]	金凌骥, 胡俊文, 李寅, 王林. 复杂颅内动脉瘤的颅内-颅内血管搭桥术[J]. 中国现代神经疾病杂志, 2024, 24(8): 606-612.
[4]	刘佩玺, 史源, 朱巍. 血流导向时代颅内全域脑血管搭桥术治疗颅内动脉瘤之应用方略[J]. 中国现代神经疾病杂志, 2024, 24(8): 613-618.
[5]	张峰, 孟凡刚. 帕金森病自主神经功能障碍丘脑底核脑深部电刺激术治疗进展[J]. 中国现代神经疾病杂志, 2024, 24(7): 510-515.
[6]	吴桂智, 田宏. Meige综合征脑深部电刺激术治疗进展[J]. 中国现代神经疾病杂志, 2024, 24(7): 516-521.
[7]	孟凡刚, 张建国. 耳后磨骨槽技术在脑深部电刺激术中的应用[J]. 中国现代神经疾病杂志, 2024, 24(7): 522-524.
[8]	陈琳, 潘华. 功能性震颤的电生理诊断[J]. 中国现代神经疾病杂志, 2024, 24(7): 573-578.
[9]	魏俊吉, 常健博. 深入基层医院普及神经外科重症管理理念[J]. 中国现代神经疾病杂志, 2024, 24(6): 403-406.
[10]	张锐, 陶永丽, 蒋晨阳, 刘凯, 许予明, 宋波. 奥法妥木单抗治疗视神经脊髓炎谱系疾病疗效分析[J]. 中国现代神经疾病杂志, 2024, 24(6): 491-496.
[11]	史若琳, 高秀洁, 崔家宁, 邵妍, 谢璐霜, 刘毅. 5-羟色胺与帕金森病非运动症状研究进展[J]. 中国现代神经疾病杂志, 2024, 24(6): 497-501.
[12]	李海峰. 在进入靶向治疗的时代激素仍然是重症肌无力治疗的基础[J]. 中国现代神经疾病杂志, 2024, 24(5): 295-307.
[13]	许鸿嘉, 舒崖清, 王蘋, 李蕃, 许顺良, 邱伟, 马晓宇. 抗水通道蛋白4抗体阳性视神经脊髓炎谱系疾病诊断与治疗进展[J]. 中国现代神经疾病杂志, 2024, 24(5): 308-314.
[14]	黄瑀, 廖金池, 舒崖清. 抗N-甲基-D-天冬氨酸受体脑炎睡眠障碍研究进展[J]. 中国现代神经疾病杂志, 2024, 24(5): 315-319.
[15]	刘彩云, 金涛. 树突状细胞在多发性硬化免疫治疗中的应用[J]. 中国现代神经疾病杂志, 2024, 24(5): 320-330.

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

2 视神经脊髓炎谱系疾病与妊娠

Neuromyelitis optica spectrum disorders and pregnancy

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价