van der Bijl A E, Emmer B J, Breedveld F C, Middelkoop H A M, Jurgens C K, van Buchem M A, Huizinga T W J, van der Grond J
Departments of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Clin Exp Rheumatol. 2007 Mar-Apr;25(2):301-4.
Neurological symptoms have been reported in patients treated with anti-TNF-alpha. In a pilot study we evaluated the effect of anti-TNF-alpha on cerebral parenchyma using advanced Magnetic Resonance (MR) techniques.
Seven patients with a systemic inflammatory disease (5 rheumatoid arthritis, 2 psoriatic arthritis) had Magnetization Transfer Imaging, Diffusion Weighted Imaging (DWI) and Magnetic Resonance Spectroscopy (MRS) of the brain before and after administration of anti-TNF-alpha. Four patients were neuropsychologically evaluated.
After treatment with TNF-alpha blocking agents the Magnetization Transfer Ratio histogram Peak-heights (MTR-Pht) of the white and gray matter decreased (p < 0.01 and p < 0.05 respectively). The Apparent Diffusion Coefficient for the white and gray matter and the metabolite ratios in the centrum semiovale did not significantly change after therapy. Neuropsychological assessment showed no difference before and after anti-TNF-alpha.
The decrease of the MTR-Pht after anti-TNF-alpha therapy suggests loss of parenchyma integrity; however, these changes could not be attributed to inflammation or demyelination based on our complementary DWI and MRS data. The decrease of the MTR-Pht did not result in decreased cognitive function.
已有接受抗肿瘤坏死因子-α（anti-TNF-alpha）治疗的患者出现神经症状的报道。在一项初步研究中，我们使用先进的磁共振（MR）技术评估了抗TNF-alpha对脑实质的影响。
7例患有全身性炎症性疾病的患者（5例类风湿性关节炎，2例银屑病关节炎）在给予抗TNF-alpha前后接受了脑部的磁化传递成像、扩散加权成像（DWI）和磁共振波谱分析（MRS）。对4例患者进行了神经心理学评估。
使用TNF-alpha阻断剂治疗后，白质和灰质的磁化传递率直方图峰值高度（MTR-Pht）降低（分别为p < 0.01和p < 0.05）。治疗后，白质和灰质的表观扩散系数以及半卵圆中心的代谢物比率没有显著变化。神经心理学评估显示抗TNF-alpha治疗前后没有差异。
抗TNF-alpha治疗后MTR-Pht降低表明实质完整性丧失；然而，根据我们补充的DWI和MRS数据，这些变化不能归因于炎症或脱髓鞘。MTR-Pht的降低并未导致认知功能下降。
