Radiologically Isolated Syndrome:10-YearRisk Estimate of a Clinical Event
Radiologically Isolated Syndrome:10-YearRisk Estimate of a Clinical Event
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DOI：
10.1002/ana.25799
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发表时间：
2020-06-29
影响因子：
11.2
通讯作者：
Okuda, Darin T.
中科院分区：
文献类型：
--
作者：
Lebrun-Frenay, Christine;Kantarci, Orhun;Okuda, Darin T.
目的我们以前已经确定男性、年轻和脊髓病变的存在是增加从放射学孤立综合征（RIS）演变为多发性硬化症的5年风险的独立因素。在这里，我们使用一个10年的、多国的、回顾性识别的RIS数据集来调查临床事件发展的风险因素。方法根据2009年RIS标准确定RIS受试者，并作为全球队列研究的一部分进行纵向随访。我们分析了来自5个不同国家的21个数据库的数据。使用多变量考克斯回归模型确定临床和磁共振成像（MRI）特征与发生首次临床事件风险之间的关联。结果451例RIS患者中有277例（86%为女性）获得了额外的随访数据。RIS诊断时的平均年龄为37.2岁（范围：11-74岁），中位临床随访时间为6.7年。10年时发生首起临床事件的累积概率为51.2%。年龄、脑脊液寡克隆带阳性、MRI幕下病变和脊髓病变是与随后临床事件相关的基线独立预测因素。随访期间钆增强病变的存在也与精液事件的风险相关。基线时MRI和钆增强病变的原因不影响后续临床事件的风险。大约一半的RIS患者在索引MRI的10年内经历了首次临床事件。识别症状发作风险的独立预测因子可能指导RIS患者的教育和临床管理。ANN NEUROL 2020
Objective We have previously identified male sex, younger age, and the presence of spinal cord lesions as independent factors that increase the 5-year risk for evolution from radiologically isolated syndrome (RIS) to multiple sclerosis. Here, we investigate risk factors for the development of a clinical event using a 10-year, multinational, retrospectively identified RIS dataset. Methods RIS subjects were identified according to 2009 RIS criteria and followed longitudinally as part of a worldwide cohort study. We analyzed data from 21 individual databases from 5 different countries. Associations between clinical and magnetic resonance imaging (MRI) characteristics and the risk of developing a first clinical event were determined using multivariate Cox regression models. Results Additional follow-up data were available in 277 of 451 RIS subjects (86% female). The mean age at RIS diagnosis was 37.2 years (range, 11-74 years), with a median clinical follow-up of 6.7 years. The cumulative probability of a first clinical event at 10 years was 51.2%. Age, positive cerebrospinal fluid for oligoclonal bands, infratentorial lesions on MRI, and spinal cord lesions, were baseline independent predictors associated with a subsequent clinical event. The presence of gadolinium-enhanced lesions during follow-up was also associated with the risk of a seminal event. The reason for MRI and gadolinium-enhancing lesions at baseline did not influence the risk of a subsequent clinical event. Interpretation Approximately half of all individuals with RIS experience a first clinical event within 10 years of the index MRI. The identification of independent predictors of risk for symptom onset may guide education and clinical management of individuals with RIS. ANN NEUROL 2020