Patterns of cerebrospinal fluid pathology correlate with disease progression in multiple sclerosis
Patterns of cerebrospinal fluid pathology correlate with disease progression in multiple sclerosis
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DOI：
10.1093/brain/124.11.2169
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发表时间：
2001-11-01
期刊：
影响因子：
14.5
通讯作者：
Hemmer, B
中科院分区：
文献类型：
--
作者：
Cepok, S;Jacobsen, M;Hemmer, B
多发性硬化症是一种慢性炎症和中枢神经系统脱髓鞘疾病，至今病因不明。多发性硬化的时间分布、强度和治疗反应高度可变，提示发病异质性。组织病理学研究揭示了至少四种不同的急性脱髓鞘病变亚型，这一假说得到了支持。虽然将多发性硬化症患者分为这些类别对临床研究非常有帮助，但这种方法不切实际，因为它需要脑活检。在这项研究中，我们调查了60例多发性硬化症患者的脑脊液细胞学流式细胞术。我们确定了不同的模式CSF细胞学，这是独立的外周血中的免疫参数。最可变的CSF参数是B细胞与单核细胞的比率，在选定的患者中，该比率在疾病的不同阶段保持稳定。在回顾性连续分析中，该比值与疾病进展相关，但与残疾或疾病持续时间无关。高比例（B细胞占优势）与更快的疾病进展相关，而低比例（单核细胞占优势）见于进展较慢的患者。我们的研究证实了不同CSF细胞学模式的存在和潜在的临床相关性。我们推测脑脊液细胞学模式可能反映了多发性硬化发病机制的异质性。
Multiple sclerosis is a chronic inflammatory and demyelinating disease of the CNS with, as yet, an unknown aetiology. Temporal profile, intensity and treatment responses are highly variable in multiple sclerosis suggesting pathogenetic heterogeneity. This hypothesis has been supported by histopathological studies disclosing at least four different subtypes of acute demyelinating lesions. Although stratification of multiple sclerosis patients into these categories would be extremely helpful for clinical studies, this approach is impractical as it requires brain biopsy. In this study we investigated CSF cytology from 60 multiple sclerosis patients by flow cytometry. We identified different patterns of CSF cytology, which were independent of immunological parameters in the peripheral blood. The most variable CSF parameter was the B cell to monocyte ratio, which remained stable during different phases of disease in selected patients. The ratio correlated with disease progression but not with disability or disease duration in a retrospective, consecutive analysis. A high ratio (predominance of B cells) was associated with more rapid disease progression, whereas a low ratio (predominance of monocytes) was found in patients with slower progression. Our study demonstrates the existence and potential clinical relevance of different CSF cytology patterns. We hypothesize that CSF cytology patterns may reflect the heterogeneity in the pathogenesis of multiple sclerosis.