Gajofatto Alberto, Monaco Salvatore, Fiorini Michele, Zanusso Gianluigi, Vedovello Marcella, Rossi Francesca, Turatti Marco, Benedetti Maria Donata
Section of Clinical Neurology, Department of Neurological and Vision Sciences, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy.
Arch Neurol. 2010 Jun;67(6):724-30. doi: 10.1001/archneurol.2010.107.
To identify predictors of short- and long-term outcomes in acute myelitis (AM).
First episodes of AM were retrospectively identified in a single institution. Information regarding demographics, clinical status, laboratory workup, magnetic resonance imaging of the spine and brain, and electrophysiological assessment was collected. Tau, 14-3-3 protein, and cystatin C levels were assessed de novo in stored cerebrospinal fluid samples.
A neurological department database. Patients Fifty-three patients with a first episode of AM.
The prognostic value of all variables was analyzed for the following outcomes: recovery from the initial event, symptom recurrence, conversion to multiple sclerosis (MS), and long-term disability.
Median follow-up was 6.2 years. Six patients (11%) remained monophasic; 5 (9%) developed recurrent myelitis; and 42 (79%) underwent conversion to MS. Sensory level absence, no sphincter involvement, abnormal magnetic resonance imaging findings in the brain, spinal cord lesions shorter than 3 vertebral segments, and abnormal somatosensory evoked potentials predicted MS conversion. Fifteen of 32 patients with pyramidal dysfunction at onset (47%) and 17 of 43 with relapses during follow-up (40%) had significant disability at the last visit compared with 2 of 21 patients without pyramidal manifestations (10%) and none of the patients without exacerbations (P = .006 and P = .02, respectively). In 11 patients with exacerbations, we observed a significant correlation between cerebrospinal fluid levels of cystatin C and the degree of neurological disability at the last visit (Spearman rho = 0.69; P = .03).
For patients with first-episode AM, the conversion rate to MS is high. Motor dysfunction at onset and relapse occurrence are associated with worse outcome. Cerebrospinal fluid levels of cystatin C may prove useful for predicting the prognosis of such patients.
确定急性脊髓炎（AM）短期和长期预后的预测因素。
在单一机构中对AM的首发病例进行回顾性识别。收集有关人口统计学、临床状况、实验室检查、脊柱和脑部磁共振成像以及电生理评估的信息。对储存的脑脊液样本重新评估 Tau、14-3-3 蛋白和胱抑素 C 水平。
神经科数据库。患者 53 例 AM 首发患者。
分析所有变量对以下结局的预后价值：从初始事件中恢复、症状复发、转化为多发性硬化症（MS）和长期残疾。
中位随访时间为 6.2 年。6 例患者（11%）仍为单相病程；5 例（9%）发生复发性脊髓炎；42 例（79%）转化为 MS。无感觉平面、无括约肌受累、脑部磁共振成像异常、脊髓病变短于 3 个椎体节段以及体感诱发电位异常可预测转化为 MS。与 21 例无锥体束征表现的患者中的 2 例（10%）以及无病情加重的患者中无一例相比，32 例起病时有锥体功能障碍的患者中有 15 例（47%）以及随访期间复发的 43 例患者中有 17 例（40%）在最后一次就诊时有明显残疾（分别为 P = 0.006 和 P = 0.02）。在 11 例病情加重的患者中，我们观察到脑脊液胱抑素 C 水平与最后一次就诊时的神经残疾程度之间存在显著相关性（Spearman 相关系数 = 0.69；P = 0.03）。
对于首发 AM 患者，转化为 MS 的发生率很高。起病时的运动功能障碍和复发与较差的结局相关。脑脊液胱抑素 C 水平可能有助于预测此类患者的预后。
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