Search for a prognostic biomarker in multiple sclerosis: a step in the right direction?
Search for a prognostic biomarker in multiple sclerosis: a step in the right direction?
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寻找多发性硬化症的预后生物标志物：朝着正确方向迈出的一步？
DOI：
10.1136/jnnp-2018-318326
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Taylor BV
中科院分区：
文献类型：
--
作者：
Taylor BV
到目前为止，没有生物标志物允许临床医生以任何程度的确定性回答他们的临床孤立综合征（CIS）患者的未来问题。在该杂志中，Rathbone et al 1提供了进一步的证据，支持在CIS时诊断性腰椎穿刺（LP）时测量的脑脊液（CSF）免疫球蛋白κ与λ游离轻链的比值（FLC κ：λ比值）在预测CIS后5年多发性硬化（MS）疾病进展中的效用。以前，MRI、临床特征、CSF中的寡克隆带（OCB）和血清/CSF神经丝组分都被认为是潜在的预后生物标志物，但都有明显的缺点，没有一个能为CIS患者或临床医生提供任何明确的确定性。最近对MRI在预测MS进展中的效用的评估概述了这种模式的局限性，并强调了需要更多的工作。2 FLC κ：λ比值预测5年时扩展残疾状态评分（EDSS）进展，CSF κ：λ FLC比值高（> 10）组的中位EDSS较低（0.0; 95% CI 0 - 2.5 vs 2.5; 95% CI 0 - 4，高vs低; p= 0.049）。
To date, no biomarker has allowed clinicians to answer the question of what the future holds for their patients with clinically isolated syndrome (CIS) with any degree of certainty. In the journal, Rathbone et al 1 provide further evidence to support the utility of the ratio of cerebrospinal fluid (CSF) immunoglobulin kappa to lambda free light chains (FLC κ: λ ratio), measured at diagnostic lumbar puncture (LP) at the time of CIS, in predicting multiple sclerosis (MS) disease progression out to 5 years post-CIS. Previously, MRI, clinical features, oligoclonal bands (OCBs) in CSF and serum/CSF neurofilament components have all been advanced as potential prognostic biomarkers, but all have significant shortcomings, and none provide any clear certainty for the patient with CIS or the clinician. A recent assessment of the utility of MRI in predicting MS progression has outlined the limitations of this modality and has emphasised the need for more work. 2The FLC κ: λ ratio predicted expanded disability status scores (EDSS) progression at 5 years, with a lower median EDSS in the group with high (> 10) CSF κ: λ FLC ratio (0.0; 95% CI 0 to 2.5 vs 2.5; 95% CI 0 to 4, high vs low; p= 0.049).