Tomassini V, De Giglio L, Reindl M, Russo P, Pestalozza I, Pantano P, Berger T, Pozzilli C
Department of Neurological Sciences, La Sapienza University, Rome, Italy.
Mult Scler. 2007 Nov;13(9):1086-94. doi: 10.1177/1352458507077622. Epub 2007 Apr 27.
The aim of this study was to test the contribution of anti-myelin antibodies in predicting conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) when considering either Poser's or McDonald's diagnostic criteria. Fifty-one patients with CIS and abnormal brain MRI were imaged monthly for six months and then at 12, 18, 24, 36 months. At baseline serum samples testing antibodies against myelin oligodendrocyte glycoprotein (anti-MOG) and myelin basic protein (anti-MBP) were collected. During the 36-month follow-up, 26 (51%) patients developed a relapse thus becoming clinically definite MS (CDMS) according to Poser's criteria; 46 (90.2%) patients converted to MS according to McDonald's criteria. Out of 51 patients, 28 (54.9%) had either double or single positivity for anti-myelin antibodies. Antibody status significantly predicted MS according to Poser's criteria (P=0.004), but did not according to the McDonald's criteria. When compared to antibody negative patients, the risk of developing a relapse was 8.9 (95% CI: 2.7-29.8; P<0.001) for anti-MBP positive (anti-MBP+) patients and 1.5 (95% CI: 0.4-5.4; P=0.564) for those anti-MOG positive (anti-MOG+); double positive patients (ie, anti-MBP+/anti-MOG+) had a risk of relapse's occurrence equal to 3.4 (95% CI: 1.1-10.2; P=0.031). Also, the antibody status predicted the median time span from CIS to CDMS, that was of 36 months in the anti-MOG-/anti-MBP- group, 33 months in the anti-MOG+/anti-MBP- group, 24 months in the anti-MOG+/anti-MBP+ group and 12 months in the anti-MOG-/anti-MBP+ patients (P=0.003 by ANOVA). Our data support the prognostic value of anti-myelin antibodies in CIS patients at risk of CDMS, with positive patients showing shorter time interval to relapse occurrence than negative patients.
本研究的目的是在考虑波泽（Poser）或麦克唐纳（McDonald）诊断标准时，测试抗髓鞘抗体在预测临床孤立综合征（CIS）向多发性硬化症（MS）转化中的作用。51例CIS且脑部MRI异常的患者每月进行一次为期6个月的成像检查，然后在12、18、24、36个月时再次成像。在基线时收集检测抗髓鞘少突胶质细胞糖蛋白（抗MOG）和髓鞘碱性蛋白（抗MBP）抗体的血清样本。在36个月的随访期间，26例（51%）患者出现复发，根据波泽标准成为临床确诊的MS（CDMS）；46例（90.2%）患者根据麦克唐纳标准转化为MS。在51例患者中，28例（54.9%）抗髓鞘抗体呈双阳性或单阳性。根据波泽标准，抗体状态可显著预测MS（P=0.004），但根据麦克唐纳标准则不能。与抗体阴性患者相比，抗MBP阳性（抗MBP+）患者发生复发的风险为8.9（95%CI：2.7-29.8；P<0.001），抗MOG阳性（抗MOG+）患者为1.5（95%CI：0.4-5.4；P=0.564）；双阳性患者（即抗MBP+/抗MOG+）复发的风险为3.4（95%CI：1.1-10.2；P=0.031）。此外，抗体状态还可预测从CIS到CDMS的中位时间跨度，抗MOG-/抗MBP-组为36个月，抗MOG+/抗MBP-组为33个月，抗MOG+/抗MBP+组为24个月，抗MOG-/抗MBP+患者为12个月（方差分析P=0.003）。我们的数据支持抗髓鞘抗体在有CDMS风险的CIS患者中的预后价值，阳性患者复发发生的时间间隔比阴性患者短。
