Spinal cord involvement by atrophy and associations with disability are different between multiple sclerosis and neuromyelitis optica spectrum disorder
Spinal cord involvement by atrophy and associations with disability are different between multiple sclerosis and neuromyelitis optica spectrum disorder
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DOI：
10.1111/ene.14038
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发表时间：
2019-08-02
影响因子：
5.1
通讯作者：
Kira, J-i.
中科院分区：
文献类型：
--
作者：
Nakamura, Y.;Liu, Z.;Kira, J-i.
背景和目的多发性硬化（MS）患者颈胸段脊髓横截面积（CS-SCA）与残疾相关，而视神经肌萎缩症谱系障碍（NMOSD）患者的CS-SCA与残疾的相关性尚待确定。我们的目的是澄清MS和NMOSD在脊髓节段CS-SCA与残疾相关的差异。方法采用抗水通道蛋白4免疫球蛋白G（AQP）检测140例MS患者（其中复发缓解型111例，进展型29例）和42例NMOSD患者C2/C3、C3/C4、T8/T9、T9/T10椎间盘水平CS-SCA。采用扩展残疾状态量表（EDSS）评分评定残疾程度。CS-SCA和残疾之间的多变量关联进行了评估逐步向前多元线性回归。结果在校正年龄、性别和病程后，NMOSD患者的胸部CS-SCA仍显著小于MS患者（T8/T9时P = 0.002），而两种疾病的颈部CS-SCA无差异。MS患者的颈部和胸部CS-SCA与EDSS评分呈负相关（C3/C4时P < 0.0001，T8/T9时P = 0.0002），而NMOSD患者中仅胸部CS-SCA与EDSS评分相关（T8/T9时P = 0.0006）。通过多元回归分析，MS残疾的预测因素是较小的颈部CS-SCA，进展过程中，年龄较大，复发次数较多，而在NMOSD较小的胸部CS-SCA和年龄较大。结论胸部CS-SCA是NMOSD患者残疾的一个有用的预测指标，而颈部CS-SCA与MS患者残疾相关。
Background and purpose The cervical and thoracic cross-sectional spinal cord area (CS-SCA) in multiple sclerosis (MS) correlates with disability, whilst such a correlation remains to be established in neuromyelitis optica spectrum disorder (NMOSD). Our aim was to clarify differences between MS and NMOSD in spinal cord segments where CS-SCA is associated with disability. Methods The CS-SCA at C2/C3, C3/C4, T8/T9 and T9/T10 vertebral disc levels was measured in 140 MS patients (111 with relapsing-remitting MS and 29 with progressive MS) and 42 NMOSD patients with anti-aquaporin-4 immunoglobulin G. Disability was evaluated by Expanded Disability Status Scale (EDSS) scores. Multivariate associations between CS-SCA and disability were assessed by stepwise forward multiple linear regression. Results Thoracic CS-SCA was significantly smaller in NMOSD patients than in MS patients even after adjusting for age, sex and disease duration (P = 0.002 at T8/T9), whilst there was no difference in cervical CS-SCA between the two diseases. Cervical and thoracic CS-SCA had a negative correlation with EDSS scores in MS patients (P < 0.0001 at C3/C4 and P = 0.0002 at T8/T9) whereas only thoracic CS-SCA correlated with EDSS scores in NMOSD patients (P = 0.0006 at T8/T9). By multiple regression analyses, predictive factors for disability in MS were smaller cervical CS-SCA, progressive course, older age and a higher number of relapses, whilst those in NMOSD were smaller thoracic CS-SCA and older age. Conclusions Thoracic CS-SCA is a useful predictive marker for disability in patients with NMOSD whilst cervical CS-SCA is associated with disability in patients with MS.