Clinically Isolated Syndrome According to McDonald 2010: Intrathecal IgG Synthesis Still Predictive for Conversion to Multiple Sclerosis.
Clinically Isolated Syndrome According to McDonald 2010: Intrathecal IgG Synthesis Still Predictive for Conversion to Multiple Sclerosis.
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DOI：
10.3390/ijms18102061
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发表时间：
2017-09-27
影响因子：
5.6
通讯作者：
Skripuletz T
中科院分区：
文献类型：
--
作者：
Schwenkenbecher P;Sarikidi A;Bönig L;Wurster U;Bronzlik P;Sühs KW;Pul R;Stangel M;Skripuletz T
虽然2010年修订的McDonald标准允许在早期诊断多发性硬化症（MS），但仍需要确定临床孤立综合征（CIS）患者转化为MS的风险因素。自最新McDonald标准建立以来，脑脊液（CSF）和视觉诱发电位（VEP）在CIS患者预后中的作用仍然不明确。我们进行了一项单中心研究，包括2010年至2015年期间的CIS患者。120例患者的随访显示，42%转化为MS。具有阳性寡克隆条带（OCB）的CIS患者转化为MS的可能性是OCB阴性患者的两倍多（风险比= 2.6）。当检测到定量鞘内IgG合成时，发生MS的概率甚至更高（风险比= 3.8）。在OCB患者中，VEP没有增加更多关于MS转换率的信息。在视神经炎和阴性OCB患者中，当VEP延迟时，MS转换率显着升高。总之，鞘内IgG合成的检测增加了MS的转换概率。病理VEP可以帮助预测没有鞘内IgG合成的视神经炎患者向MS的转换率。
While the revised McDonald criteria of 2010 allow for the diagnosis of multiple sclerosis (MS) in an earlier stage, there is still a need to identify the risk factors for conversion to MS in patients with clinically isolated syndrome (CIS). Since the latest McDonald criteria were established, the prognostic role of cerebrospinal fluid (CSF) and visual evoked potentials (VEP) in CIS patients is still poorly defined. We conducted a monocentric investigation including patients with CIS in the time from 2010 to 2015. Follow-ups of 120 patients revealed that 42% converted to MS. CIS patients with positive oligoclonal bands (OCB) were more than twice as likely to convert to MS as OCB negative patients (hazard ratio = 2.6). The probability to develop MS was even higher when a quantitative intrathecal IgG synthesis was detected (hazard ratio = 3.8). In patients with OCB, VEP did not add further information concerning the conversion rate to MS. In patients with optic neuritis and negative OCB, a significantly higher rate converted to MS when VEP were delayed. In conclusion, the detection of an intrathecal IgG synthesis increases the conversion probability to MS. Pathological VEP can help to predict the conversion rate to MS in patients with optic neuritis without an intrathecal IgG synthesis.
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