Axonal transection in the lesions of multiple sclerosis
Axonal transection in the lesions of multiple sclerosis
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DOI：
10.1056/nejm199801293380502
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发表时间：
1998-01-29
影响因子：
158.5
通讯作者：
Bö, L
中科院分区：
文献类型：
--
作者：
Trapp, BD;Peterson, J;Bö, L
背景多发性硬化症是一种中枢神经系统炎症性脱髓鞘疾病，是导致年轻人神经功能障碍的最常见原因。尽管接受了抗炎或免疫抑制治疗，但大多数患者都有进行性的神经恶化，这可能反映了轴突的丧失。方法11例多发性硬化症患者和4例非脑部疾病患者尸检获得脑组织标本。用免疫组织化学和共聚焦显微镜检查了14个活动性多发性硬化症病变、33个慢性活动性病变和外观正常的白质样本的脱髓鞘、炎症和轴突病理变化。结果轴突横断是多发性硬化症病变的一贯特征，其出现频率与病变的炎症程度有关。活动期病变平均每立方毫米轴突数为11,236个，慢性活动期病变边缘的轴突平均为3138个，慢性活动期病变中心的轴突平均为875个，正常脑白质中的轴突平均不到1个。结论轴突横断在多发性硬化症的病变中很常见，轴突横断可能是本病不可逆神经功能损害的病理基础。(C)1998年，马萨诸塞州医学会。
Background Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system and is the most common cause of neurologic disability in young adults. Despite antiinflammatory or immunosuppressive therapy, most patients have progressive neurologic deterioration that may reflect axonal loss. We conducted pathological studies of brain tissues to define the changes in axons in patients with multiple sclerosis.Methods Brain tissue was obtained at autopsy from 11 patients with multiple sclerosis and 4 subjects without brain disease. Fourteen active multiple-sclerosis lesions, 33 chronic active lesions, and samples of normal-appearing white matter were examined for demyelination, inflammation, and axonal pathologic changes by immunohistochemistry and confocal microscopy. Axonal transection, identified by the presence of terminal axonal ovoids, was detected in all 47 lesions and quantified in 18 lesions.Results Transected axons were a consistent feature of the lesions of multiple sclerosis, and their frequency was related to the degree of inflammation within the lesion. The number of transected axons per cubic millimeter of tissue averaged 11,236 in active lesions, 3138 at the hypocellular edges of chronic active lesions, 875 in the hypocellular centers of chronic active lesions, and less than 1 in normal-appearing white matter from the control brains.Conclusions Transected axons are common in the; lesions of multiple sclerosis, and axonal transection may be the pathologic correlate of the irreversible neurologic impairment in this disease. (C) 1998, Massachusetts Medical Society.