Importance of cerebrospinal fluid analysis in the era of McDonald 2010 criteria: a German-Austrian retrospective multicenter study in patients with a clinically isolated syndrome
Importance of cerebrospinal fluid analysis in the era of McDonald 2010 criteria: a German-Austrian retrospective multicenter study in patients with a clinically isolated syndrome
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DOI：
10.1007/s00415-016-8302-1
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发表时间：
2016-12-01
影响因子：
6
通讯作者：
Tumani, Hayrettin
中科院分区：
文献类型：
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作者：
Huss, Andre M.;Halbgebauer, Steffen;Tumani, Hayrettin
大多数首次出现临床症状提示多发性硬化症(MS)的患者不符合2010年修订的McDonald多发性硬化症(MS)诊断标准中MRI在空间和时间上的扩散标准，因此被归类为临床隔离综合征(CIS)。为了根据2010年修订的McDonald标准重新评估脑脊液(CSF)分析的实用性，我们进行了一项旨在确定CIS患者中寡克隆性免疫球蛋白条带(OCB)的患病率和预测价值的多中心回顾性研究。患者来自德国和奥地利的十个专科多发性硬化症中心。我们收集了406名患者的数据；在发病时，44/406(11%)符合McDonald 2010年的MS标准，310/362(86%)的CIS患者鞘内检测到OCBs。根据麦克唐纳2010年的标准，这些患者转变为多发性硬化症的可能性是OCB阴性患者的两倍(风险比=2.1p=0.0014)，并且在较短的时间内(95%可信区间21-34)，与OCB阴性个体的47个月(95%可信区间36-85)相比。首次发病时无脑损害且鞘内有OCBs者(30/44)，中转为MS者为60%(18/30)，而无OCBs者仅为21%(3/14)。我们的数据证实，在CIS患者中，如果发病时存在OCB，则转换为MS的风险显著增加。根据修订的McDonald标准，脑脊液分析绝对有助于评估未患多发性硬化症的患者的预后。
The majority of patients presenting with a first clinical symptom suggestive of multiple sclerosis (MS) do not fulfill the MRI criteria for dissemination in space and time according to the 2010 revision of the McDonald diagnostic criteria for MS and are thus classified as clinically isolated syndrome (CIS). To re-evaluate the utility of cerebrospinal fluid (CSF) analysis in the context of the revised McDonald criteria from 2010, we conducted a retrospective multicenter study aimed at determining the prevalence and predictive value of oligoclonal IgG bands (OCBs) in patients with CIS. Patients were recruited from ten specialized MS centers in Germany and Austria. We collected data from 406 patients; at disease onset, 44/406 (11 %) fulfilled the McDonald 2010 criteria for MS. Intrathecal IgG OCBs were detected in 310/362 (86 %) of CIS patients. Those patients were twice as likely to convert to MS according to McDonald 2010 criteria as OCB-negative individuals (hazard ratio = 2.1, p = 0.0014) and in a shorter time period of 25 months (95 % CI 21-34) compared to 47 months in OCB-negative individuals (95 % CI 36-85). In patients without brain lesions at first attack and presence of intrathecal OCBs (30/44), conversion rate to MS was 60 % (18/30), whereas it was only 21 % (3/14) in those without OCBs. Our data confirm that in patients with CIS the risk of conversion to MS substantially increases if OCBs are present at onset. CSF analysis definitely helps to evaluate the prognosis in patients who do not have MS according to the revised McDonald criteria.