Amato M P, Ponziani G
Department of Neurology, University of Florence, Italy.
Neurol Sci. 2000;21(4 Suppl 2):S831-8. doi: 10.1007/s100720070021.
Two hundred and twenty-four patients at their first diagnosis of multiple sclerosis (MS) were prospectively followed for a mean period of 9.78 years. We considered as endpoints the time to reach non-reversible disability levels corresponding to EDSS scores of 4.0 and 6.0, and the beginning of a secondary progressive phase in the relapsing-remitting subgroup of patients. An initially progressive course and higher basal EDSS scores proved to be the best predictors of unfavorable prognosis. A greater number of functional systems involved at onset as well as higher residual deficits in pyramidal, visual, sphincteric and cerebellar systems were other factors predictive of a poor outcome, whereas sensory system involvement turned out to be favorable. A longer first inter-attack interval was associated with a better prognosis. However, overall number of relapses in the first two years of the disease was of no prognostic value. The presence of oligoclonal banding in the cerebrospinal fluid and a cerebral MRI exam strongly suggestive or suggestive of MS in the early phases of the disease were associated with a higher probability of a worse outcome.
224例初诊为多发性硬化症（MS）的患者接受了前瞻性随访，平均随访时间为9.78年。我们将达到对应于扩展残疾状态量表（EDSS）评分4.0和6.0的不可逆残疾水平的时间，以及复发缓解型患者亚组中继发进展期的开始作为终点。最初的进展型病程和较高的基础EDSS评分被证明是不良预后的最佳预测指标。起病时涉及的功能系统数量较多，以及锥体、视觉、括约肌和小脑系统中较高的残留缺陷是其他预测不良结局的因素，而感觉系统受累则预后良好。首次发作间隔时间较长与较好的预后相关。然而，疾病前两年的复发总数没有预后价值。脑脊液中寡克隆带的存在以及在疾病早期强烈提示或提示MS的脑部MRI检查与预后较差的可能性较高相关。
