【摘要】 目的 探讨视神经脊髓炎谱系疾病(NMOSD)患者首次确诊时疾病严重程度的可能危险因素。方法 采用回顾性方法，选取2013年1月至2023年4月于郑州大学第一附属医院新诊断为NMOSD的299例病例作为研究对象。收集的资料涵盖人口学特征(如年龄、性别)、生活习惯(吸烟史、饮酒史)、既往疾病史(高血压、糖尿病、自身免疫性疾病)、首次发病时的症状、初始扩展残疾状态量表评分(EDSS)、水通道蛋白4(AQP-4)抗体状态、白蛋白、球蛋白、凝血酶原时间(PT)、纤维蛋白原(Fib)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、MRI。通过二元logistic回归模型，对影响首发NMOSD患者疾病严重程度的潜在危险因素进行统计学分析。通过受试者工作特征(ROC)曲线评估纤维蛋白原与白蛋白比值(FAR)对疾病严重程度的预测能力。结果 在首次发作的NMOSD患者中，中重度组患者相比轻度组患者FAR显著增加(P<0.001)。单因素二元logistic回归分析(OR=1.635,95%CI:1.348～1.983,P<0.001)和多因素二元logistic回归分析(OR=1.481,95%CI:1.169～1.876,P=0.001)均显示FAR与首次发作的NMOSD患者疾病严重程度显著相关。曲线下面积(AUC)是0.681(95%CI:0.618～0.743)，当FAR > 5.797时，首发NMOSD患者神经功能障碍更严重，其灵敏度为81.8%，特异度为47.3%。结论 FAR是首次发作的NMOSD患者疾病严重程度的独立危险因素。更多还原

【Abstract】 Objective This study aimed to explore the risk factors associated with disease severity in patients experiencing their initial attack of neuromyelitis optica spectrum disorders( NMOSD). Methods In this retrospective analysis,two hundred and ninety-nine patients newly diagnosed with NMOSD at the First Affiliated Hospital of Zhengzhou University from January 2013 to April 2023 were enrolled. The collected data encompassed demographic characteristics( such as age and gender),lifestyle habits( including smoking and alcohol consumption history),and past medical history( including hypertension,diabetes,and autoimmune diseases),symptoms at the onset of the first attack,initial expanded disability status scale( EDSS) score,aquaporin-4( AQP-4) antibody status,albumin,globulin,prothrombin time( PT),fibrinogen( Fib),activated partial thromboplastin time( APTT),thrombin time( TT),and MRI. A binary logistic regression was performed to analyze the risk factors for disease severity in first-episode NMOSD patients. Concurrently,the predictive value of the fibrinogen-to-albumin ratio( FAR) was evaluated through receiver operating characteristic( ROC) curve analysis. Results Among patients with firstepisode NMOSD,FAR increased in the moderate-to-severe patient group compared with the mild patient group( P < 0. 001).Single factor binary logistic regression analysis( OR = 1. 635,95% CI: 1. 348-1. 983,P < 0. 001) and multivariate binary logistic regression analysis( OR = 1. 481,95% CI: 1. 169-1. 876,P = 0. 001) revealed a significant association of FAR with disease severity in patients with first-episode NMOSD. The area under the curve( AUC) was 0. 681( 95% CI: 0. 618-0. 743). When FAR was > 5. 797,there was more severe neurological dysfunction in patients with first-episode NMOSD,with a sensitivity and specificity of 81. 8% and 47. 3%,respectively. Conclusion FAR is an independent risk factor for disease severity in patients with first-episode NMOSD.更多还原