One year follow up study of primary and transitional progressive multiple sclerosis
One year follow up study of primary and transitional progressive multiple sclerosis
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DOI：
10.1136/jnnp.68.6.713
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发表时间：
2000-06-01
影响因子：
11
通讯作者：
Thompson, AJ
中科院分区：
文献类型：
--
作者：
Stevenson, VL;Miller, DH;Thompson, AJ
目的：记录一年来原发性和过渡性进行性多发性硬化症（PP和TP MS）患者的临床和磁共振成像（MRI）特征。导语：PP或TP型多发性硬化患者的脑T2和TI病变负荷低，新病变形成速度慢，钆增强最小，尽管他们的残疾积累。需要对这些患者进行系列评估，以阐明导致疾病进展的病理过程，并确定可以在治疗试验中监测这些过程的临床和MRI措施。方法：从6个欧洲中心招募的患者，每隔1年接受两次扩展残疾状态量表（EDSS）和脑和脊髓MRI评估。结果167例患者（137例PP多发性硬化，30例TP多发性硬化）中，41例（25%；35例PP， 6例TP） EDSS升高1级。PP组平均新发脑病变数为0.88个，TP MS组平均新发脑病变数为0.47个。两组患者的T2病变负荷在一年内都发生了变化（p <或等于0.002），PP组的中位百分比变化为7.3%，TP MS组的中位百分比变化为10.8%。PP组T1负荷也有显著变化（p< 0.001，中位变化12.6%）。观察到的新脊髓病变数量较少（PP组平均0.14，TP组无新脊髓病变）。两组均显示脊髓横截面积减少（p< 0.001，中位数变化；PP 3.8%, TP 4.9%），但只有PP组显示显著脑萎缩（p< 0.001, 0.95%）。结论：尽管在该患者组中监测疾病进展是困难的，但该研究显示了病变负荷和萎缩的变化，如果这些变化与较长时间的临床变化相关，将有助于治疗性试验的设计。
Objective-To document clinical and magnetic resonance imaging (MRI) characteristics of a large cohort of primary and transitional progressive multiple sclerosis (PP and TP MS) patients over one year. Introduction-Patients with PP or TP MS have been shown to have low brain T2 and TI lesion loads and slow rates of new lesion formation with minimal gadolinium enhancement, despite their accumulating disability. Serial evaluation of these patients is needed to elucidate the pathological processes responsible for disease progression and to identify clinical and MRI measures which can monitor these processes in treatment trials.Method-Patients, recruited from six European centres, underwent two assessments on the expanded disability status scale (EDSS) and MRI of the brain and spinal cord, 1 year apart.Results-Of the 167 patients studied (137 with PP MS and 30 with TP MS), 41 (25%; 35 PP and six TP) showed a one step increase in the EDSS. The mean number of new brain lesions seen was 0.88 in the PP group and 0.47 in the TP MS group. Both groups demonstrated change in T2 lesion load over the year (p less than or equal to 0.002), with median percentage changes of 7.3% in the PP group and 10.8% in the TP MS group. The PP group also showed a significant change in T1 load (p< 0.001, median change 12.6%). The number of new cord lesions seen was small (mean of 0.14 in the PP group and no new cord lesions in the TP group). Both groups demonstrated a decrease in cord cross sectional area (p< 0.001, median changes; PP 3.8%, TP 4.9%), but only the PP group showed evidence of significant brain atrophy (p< 0.001, 0.95%).Conclusion-Although the monitoring of disease progression in this patient group is difficult, this study demonstrates changes in both lesion load and atrophy, which, if shown to correlate with clinical change over a longer time will facilitate therapeutic trial design.