Horakova D, Cox J L, Havrdova E, Hussein S, Dolezal O, Cookfair D, Dwyer M G, Seidl Z, Bergsland N, Vaneckova M, Zivadinov R
Department of Neurology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic.
J Neurol Neurosurg Psychiatry. 2008 Apr;79(4):407-14. doi: 10.1136/jnnp.2007.120378. Epub 2007 Jun 5.
There is growing evidence for the concept of multiple sclerosis (MS) as an inflammatory neurodegenerative disease, with a different pattern of atrophy evolution in grey matter (GM) and white matter (WM) tissue compartments.
We aimed to investigate the evolution of different MRI measures in early relapsing-remitting patients with MS and in normal controls (NCs) over 2 years. We also evaluated the progression of these MRI measures in a subset of patients who were followed for up to 5 years.
Included in this study were 147 patients who participated in the combination ASA (Avonex Steroids Azathioprine) study and completed full treatment, clinical and MRI assessment at 0, 12 and 24 months. A subgroup of 66 patients was followed for 36 months, 51 patients for 48 months and 43 patients for 60 months. Mean age at baseline was 30.7 years, mean disease duration was 5.5 years, mean EDSS was 1.8 and mean annualised relapse rate before study entry was 1.7. MRI scans were performed on a 1.5T scanner every 2 months for the first 2 years and thereafter once yearly for up to 5 years. In addition to the MS group, 27 NCs were examined at months 0, 12 and 24 using the same MRI protocol. Percentage brain volume change (PBVC), GM volume (GMV), WM volume (WMV) and peripheral grey volume (PGV) were measured annually using SIENA/X software. T2-hyperintense lesion volume (LV), lateral ventricle volume (LVV) and third ventricle width (3VW) were also assessed annually.
Over the period of 0-24 months, patients with MS lost significantly more GMV (-2.6% vs -0.72%, p<0.001), PGV (-2.4% vs -1.03%, p<0.001) and PBVC (-1.2% vs -0.22%, p<0.001), and increased in LVV (+16.6% vs +0.55%, p<0.003) and 3VW (+9.3% vs 0%, p = 0.003), when compared with NCs. Within-person change in MRI measures for patients with MS over 5 years was -4.2% for PBVC, -6.2% for GMV, -5.8% for PGV, -0.5% for WMV (all p<0.001), +68.7 for LVV (p<0.001), +4% for 3VW (p<0.001) and +42% for T2-LV (p<0.001).
Our study confirmed a different pattern of GM, WM and central atrophy progression over 2 years between patients with MS and NCs. The study showed a different evolution of tissue compartment atrophy measures in patients with MS, with faster decline in cortical and deep GM regions, as well as periventricular WM regions, over a 5-year period.
越来越多的证据支持多发性硬化症（MS）是一种炎症性神经退行性疾病的概念，其在灰质（GM）和白质（WM）组织区域具有不同的萎缩演变模式。
我们旨在研究早期复发缓解型MS患者和正常对照（NCs）在2年期间不同MRI测量指标的演变情况。我们还评估了部分随访长达5年的患者这些MRI测量指标的进展情况。
本研究纳入了147名参与联合ASA（阿沃尼单抗、类固醇、硫唑嘌呤）研究并在0、12和24个月完成全面治疗、临床和MRI评估的患者。66名患者的亚组随访了36个月，51名患者随访了48个月，43名患者随访了60个月。基线时的平均年龄为30.7岁，平均病程为5.5年，平均扩展残疾状态量表（EDSS）评分为1.8，研究入组前的平均年化复发率为1.7。在最初2年中，每2个月在1.5T扫描仪上进行一次MRI扫描，此后每年进行一次，最长持续5年。除MS组外，27名NCs在0、12和24个月时使用相同的MRI方案进行检查。每年使用SIENA/X软件测量脑体积变化百分比（PBVC）、GM体积（GMV）、WM体积（WMV）和外周灰质体积（PGV）。每年还评估T2高信号病变体积（LV）、侧脑室体积（LVV）和第三脑室宽度（3VW）。
在0至24个月期间，与NCs相比，MS患者的GMV（-2.6%对-0.72%，p<0.001）、PGV（-2.4%对-1.03%，p<0.001）和PBVC（-1.2%对-0.22%，p<0.001）损失显著更多，LVV（+16.6%对+0.55%，p<0.003）和3VW（+9.3%对0%，p = 0.003）增加。MS患者5年期间MRI测量指标的个体内变化为PBVC -4.2%，GMV -6.2%，PGV -5.8%，WMV -0.5%（均p<0.001），LVV +68.7（p<0.001），3VW +4%（p<0.001），T2-LV +42%（p<0.001）。
我们的研究证实了MS患者和NCs在2年期间GM、WM和中枢萎缩进展的不同模式。该研究显示了MS患者组织区域萎缩测量指标的不同演变情况，在5年期间皮质和深部GM区域以及脑室周围WM区域的下降更快。
