Kornek Barbara, Lassmann Hans
Brain Research Institute, Division of Neuroimmunology, A-1090 Vienna, Austria.
Brain Res Bull. 2003 Aug 15;61(3):321-6. doi: 10.1016/s0361-9230(03)00095-9.
Multiple sclerosis is a chronic inflammatory disease of the central nervous system with profound heterogeneity in clinical course, neuroradiological presentation and response to therapy. The pathological analysis of 235 actively demyelinating lesions coming from three centers revealed different structural and immunological features suggesting that different pathogenetic mechanisms are involved in lesion formation. On the basis of the presence or absence of immunoglobulin and complement deposition, myelin protein loss and the patterns of oligodendrocyte degeneration beside a T cell- and macrophage-dominated immune response, four distinct patterns of demyelination have been identified. In this short review, possible paraclinical markers for tissue destruction on the basis of the main features of myelin destruction are discussed. Furthermore, the importance of early axonal damage in multiple sclerosis is highlighted.
多发性硬化症是一种中枢神经系统的慢性炎症性疾病，在临床病程、神经放射学表现及对治疗的反应方面存在显著异质性。对来自三个中心的235个活动性脱髓鞘病灶进行的病理分析揭示了不同的结构和免疫特征，这表明不同的致病机制参与了病灶形成。根据免疫球蛋白和补体沉积的有无、髓鞘蛋白丢失以及少突胶质细胞变性模式，除了以T细胞和巨噬细胞为主导的免疫反应外，还确定了四种不同的脱髓鞘模式。在这篇简短的综述中，我们将基于髓鞘破坏的主要特征讨论可能的组织破坏的临床旁指标。此外，还强调了早期轴索损伤在多发性硬化症中的重要性。
