Lin X, Blumhardt L D
Division of Clinical Neurology, Faculty of Medicine, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH, UK.
J Neurol Sci. 2001 Aug 15;189(1-2):99-104. doi: 10.1016/s0022-510x(01)00576-7.
Brain atrophy may be a useful surrogate marker of axonal loss and disease progression in multiple sclerosis (MS). Several studies have suggested that inflammatory disease activity is a risk factor for atrophy in the early stages of the disease, but may become less important later in the disease course. We aimed to investigate the relationships between atrophy and active inflammation at different stages of the disease course using brain volume measurements from magnetic resonance imaging (MRI) in patients with both relapsing-remitting (RR) (n=95) and secondary progressive (SP) (n=76) MS. Conventional dual echo and three-dimensional magnetization-prepared rapid-acquisition gradient echo imaging were performed in all patients and in 31 healthy controls. Supratentorial and infratentorial brain, and lateral ventricular volumes were determined using modern design stereology. Patients with SP MS had smaller supratentorial (p=0.003) and infratentorial brain volumes (p=0.0003), and larger lateral ventricles (p=0.02) than patients with RR MS. RR MS patients with T(1)-enhancing lesions had smaller supratentorial (p=0.02) and infratentorial (p=0.002) brain volumes and larger ventricles (p=0.002) than those without enhancing lesions. SP MS patients with enhancing lesions also had significantly larger lateral ventricles (p=0.03). Categorical analysis showed that more RR MS patients with enhancing lesions had smaller supratentorial brain (p=0.005), or larger lateral ventricular (p=0.028) volumes, and more SP MS patients with enhancing lesions had increased lateral ventricle volumes (p=0.013), than patients without enhancements. The number of enhancing lesions was significantly correlated with lateral ventricular volumes in both RR MS (r=0.39, p=0.0001) and SP MS (r=0.46, p<0.0001). Our data shows that the presence of active inflammation on a single MRI in the course of RR and SP MS, is associated with a higher risk and higher level of brain atrophy. These findings emphasise the important long-term relationship between inflammation and atrophy in MS and provide additional support for the strategy of early anti-inflammatory treatment to protect tissue integrity.
脑萎缩可能是多发性硬化症（MS）中轴突损失和疾病进展的一个有用替代指标。多项研究表明，炎症性疾病活动是疾病早期萎缩的一个危险因素，但在疾病后期可能变得不那么重要。我们旨在利用复发缓解型（RR）（n = 95）和继发进展型（SP）（n = 76）MS患者的磁共振成像（MRI）脑容量测量结果，研究疾病病程不同阶段萎缩与活动性炎症之间的关系。对所有患者和31名健康对照者进行了传统的双回波和三维磁化准备快速采集梯度回波成像。使用现代设计的体视学方法测定幕上和幕下脑以及侧脑室体积。与RR MS患者相比，SP MS患者的幕上脑体积（p = 0.003）和幕下脑体积更小（p = 0.0003），侧脑室更大（p = 0.02）。与无强化病灶的RR MS患者相比，有T（1）强化病灶的RR MS患者的幕上脑体积（p = 0.02）和幕下脑体积更小（p = 0.002），脑室更大（p = 0.002）。有强化病灶的SP MS患者的侧脑室也明显更大（p = 0.03）。分类分析显示，与无强化的患者相比，有强化病灶的RR MS患者中更多患者的幕上脑体积更小（p = 0.005）或侧脑室体积更大（p = 0.028），有强化病灶的SP MS患者中更多患者的侧脑室体积增加（p = 0.013）。在RR MS（r = 0.39，p = 0.0001）和SP MS（r = 0.46，p < 0.0001）中，强化病灶的数量均与侧脑室体积显著相关。我们的数据表明，在RR和SP MS病程中单次MRI上存在活动性炎症与更高的脑萎缩风险和更高程度的脑萎缩相关。这些发现强调了MS中炎症与萎缩之间重要的长期关系，并为早期抗炎治疗以保护组织完整性的策略提供了额外支持。
