Heterogeneity and continuum of multiple sclerosis in Japanese according to magnetic resonance imaging findings
Heterogeneity and continuum of multiple sclerosis in Japanese according to magnetic resonance imaging findings
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DOI：
10.1016/j.jns.2007.09.010
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发表时间：
2008-03-15
影响因子：
4.4
通讯作者：
Kira, Jun-Ichi
中科院分区：
文献类型：
--
作者：
Matsuoka, Takeshi;Matsushita, Takuya;Kira, Jun-Ichi
亚洲人多发性硬化症（MS）有两种不同的亚型：视神经脊髓型（OSMS）和常规型（CMS）。延伸至三个或更多椎体节段的纵向广泛性脊髓病变（LESCL）是OSMS患者的特征，但在亚洲人中，四分之一的CMS患者也有LESCL。为了明确OSMS和CMS中LESCL的区别，并描述LESCL的存在与脑磁共振成像（MRI）结果之间的关系，我们研究了142例临床确诊的复发缓解型MS患者和12例原发性进展型MS（PPMS）患者的全脊髓和脑MRI。前者按Poser标准诊断，其中OSMS 57例，CMS 67例，脑干脊髓型MS 18例;后者按McDonald标准诊断。在整个临床过程中，OSMS患者中LESCL的存在明显比CMS患者更常见，而符合Barkhof标准的脑病变（Barkhof脑病变）在CMS患者中明显比OSMS患者更常见。OSMS患者的LESCL最常累及上至中胸髓，累及全脊髓或中央灰质。相比之下，CMS患者中70%的LESCL主要累及颈髓中部的外周白色物质。PPMS患者的LESCL也显示优先累及颈髓中部的外周白色物质。三分之一的OSMS患者在发病后10年以上既没有LESCL也没有Barkhof脑病变，并且表现出比患有LESCL的OSMS患者明显更轻的残疾。这些研究结果表明，LESCL是异质性的OSMS和CMS患者之间，有不同的亚型MS在日本，根据临床和MRI结果。(c)2007 Elsevier B. V.保留所有权利。
There are two distinct subtypes of multiple sclerosis (MS) in Asians: optic-spinal (OSMS) and conventional (CMS). Longitudinally extensive spinal cord lesions (LESCLs) extending over three or more vertebral segments are characteristic of patients with OSMS, yet in Asians, one-fourth of CMS patients also have LESCLs. To clarify the distinction between LESCLs in OSMS and CMS, and to characterize the relationship between the presence of LESCLs and brain magnetic resonance imaging (MRI) findings, we studied 142 patients with clinically definite MS of relapsing-remitting onset and 12 patients with primary progressive MS (PPMS) by MRI of the whole spinal cord and brain. The former was diagnosed by Poser criteria, including 57 with OSMS, 67 with CMS and 18 with brainstem-spinal form of MS, while the latter by McDonald criteria. The presence of LESCLs throughout the entire clinical course was significantly more common in OSMS patients than in CMS patients, while brain lesions fulfilling the Barkhof criteria (Barkhof brain lesions) were significantly more common in CMS patients than OSMS patients. LESCLs in OSMS patients most frequently affected the upper to middle thoracic cord, with either holocord or central gray matter involvement. By contrast, 70% of LESCLs in CMS patients predominantly affected the peripheral white matter of the mid-cervical cord. LESCLs in patients with PPMS also showed preferential involvement of the peripheral white matter of the mid-cervical cord. One-third of OSMS patients had neither LESCLs nor Barkhof brain lesions more than 10 years after disease onset, and showed significantly milder disability than OSMS patients with LESCLs. These findings suggest that LESCLs are heterogeneous between OSMS and CMS patients, and that there are distinct subtypes of MS in Japanese, according to clinical and MRI findings. (c) 2007 Elsevier B.V. All rights reserved.