Conversion of clinically isolated syndrome to multiple sclerosis: a prospective study
Conversion of clinically isolated syndrome to multiple sclerosis: a prospective study
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DOI：
10.1016/j.msard.2020.102262
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发表时间：
2020-09-01
影响因子：
4
通讯作者：
Benesova, Yvonne
中科院分区：
文献类型：
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作者：
Kolcava, Jan;Kocica, Jan;Benesova, Yvonne
背景：多发性硬化（MS）开始于急性临床发作（临床孤立综合征），约85%的患者。在以前的研究中，从临床孤立综合征到多发性硬化症的转化率为30%至82%。当一个人在CNS炎症单次发作后进行评估时，需要做出几个关于后续几年随访的决定，包括是否开始治疗。因此，有一个新的需要，以确定预测因素，预计从CIS转换为MS。本文介绍了一项单中心前瞻性纵向研究，旨在利用2010年McDonald MS标准，并侧重于选定的人口统计学、临床、放射学（磁共振成像- MRI）、脑脊液（主要是寡克隆带- OCB）和电生理参数（多模态感觉和运动诱发电位- EP）。评价了符合MS标准的两个独立结局：第二次临床复发（临床确诊的多发性硬化症）和磁共振成像进展（基于新的MRI T2脑和/或脊髓病变）。临床随访CIS患者，在至少24个月的随访期内，在1年和2年时重复MRI（中位数27，范围24-36个月）。在入组的64例完成至少2年随访期的CIS患者中，（42名女性和22名男性，中位年龄36.5岁，范围22-66岁），45名（70.3%）（29名女性和16名男性，中位年龄38岁;范围22-66岁）符合2010年McDonald MS标准（通过随访期间的空间传播（DIS）和时间传播（DIT））。29例CIS患者通过临床症状发作转化为MS，16例CIS患者在MRI上出现新的T2病变，而19例无进展患者保持稳定为CIS。在CIS患者转化为MS的潜在预测因素中，确认基线MRI T2高信号病变（比值比（OR）3.107，p = 0.046）、OCB阳性（OR 5.958，p = 0.003）和亚临床EP异常（OR 14.400，p = 0.003）增加（>10）。多元统计模型（逻辑回归和考克斯比例风险回归模型）证实这些参数是高灵敏度（84%）和可接受特异性（63%）的独立预测因子。除了CIS向MS转化的公认预测因素外，（即基线MRI T2病变负荷和OCB阳性），已在MS的当前诊断标准中实施，此外，本研究表明，亚临床多模态诱发电位异常的高预测价值。
Background: Multiple sclerosis (MS) begins with an acute clinical attack (clinically isolated syndrome) in approximately 85% of patients. The conversion rate from clinically isolated syndrome to multiple sclerosis has been documented at 30% to 82% in previous studies. When an individual presents for evaluation after a single episode of inflammation of the CNS, several decisions regarding follow-up in subsequent years need to be made, including that of whether or not to start a therapy. There is, therefore, an emerging need to identify the predictive factors that anticipate conversion from CIS to MS.Methods: This paper presents a single-center prospective longitudinal study aimed at identification of the most powerful independent predictors for conversion from CIS to MS, utilizing the 2010 McDonald MS criteria and focusing on selected demographic, clinical, radiographical (magnetic resonance imaging - MRI), cerebrospinal fluid (predominantly oligoclonal bands - OCB) and electrophysiological parameters (multimodal sensory and motor-evoked potentials - EP). Two independent outcomes meeting MS criteria are evaluated: development of second clinical relapse (clinically definite multiple sclerosis) and progression in magnetic resonance imaging (based on new MRI T2 brain and/or spinal cord lesions). CIS patients were followed clinically and MRI was repeated at one and two years within the course of a follow-up period of at least 24 months (median 27, range 24-36 months).Results: Of the 64 CIS patients enrolled who completed at least a 2-year follow-up period (42 women and 22 men, median age 36.5, range 22-66 years), 45 (70.3%) (29 women and 16 men, median age 38; range 22-66 years) fulfilled the 2010 McDonald criteria for MS by dissemination in space (DIS) and time (DIT) over the follow-up period. Twenty-nine CIS patients converted to MS through a clinically symptomatic attack, and 16 CIS patients developed new T2 lesions on MRI, while 19 patients without progression remained stable as CIS. Confirmed among potential predictors for the conversion of CIS patients to MS were increased (>10) baseline MRI T2-hyperintense lesions (odds ratio (OR) 3.107, p = 0.046), OCB positivity (OR 5.958, p = 0.003) and subclinical EP abnormality (OR 14.400, p = 0.003). Multivariate statistical models (logistic regression and Cox proportional hazards regression models) confirmed these parameters as independent predictors of high sensitivity (84%) and acceptable specificity (63%).Conclusion: In addition to accepted predictors for the conversion of CIS to MS (i.e. baseline MRI T2 lesion load and OCB positivity), already implemented in current diagnostic criteria for MS, this study demonstrates, in addition, the high predictive value of subclinical multimodal evoked potential abnormalities.