进展性多发性硬化与慢性脑脊髓静脉功能不全无关。

Progressive multiple sclerosis is not associated with chronic cerebrospinal venous insufficiency.

机构信息

First Neurology Clinic, Department of Neuroscience, University of Padua, Padova, Italy.

出版信息

Neurology. 2011 Aug 30;77(9):844-50. doi: 10.1212/WNL.0b013e31822c6208. Epub 2011 Aug 17.

DOI:10.1212/WNL.0b013e31822c6208

PMID:21849656

Abstract

OBJECTIVE

Chronic cerebrospinal venous insufficiency (CCSVI) had been suggested to play a major pathogenetic role in multiple sclerosis (MS), but recent data on early stages of MS have not confirmed this theory. Nonetheless, CCSVI could represent a late phenomenon of MS or be associated with progression of disability. Thus, we studied CCSVI prevalence in primary progressive (PP) and secondary progressive (SP) MS, to clarify whether CCSVI characterizes the progressive forms of this disease.

METHODS

A total of 35 patients with SPMS, 25 patients with PPMS, and 60 age- and gender-matched normal controls (NC) were enrolled into a cross-sectional study. Extracranial and transcranial high-resolution venous echo color Doppler sonography (ECDS-TCDS) was performed in all patients and NC. Those patients having any abnormal ultrasound finding were asked to undergo selective venography (VGF).

RESULTS

Patients with PPMS (11 women, 14 men; mean age 47 ± 11 years) had a disease duration of 11 ± 7 years and Expanded Disability Status Scale (EDSS) score of 6.0 ± 0.5. Patients with SPMS (22 women, 13 men; mean age 45 ± 14.5 years) had a disease duration of 18 ± 14 years and EDSS score of 6.0 ± 0.8. TCDS was normal in all patients. ECDS showed one or more abnormal findings in 9/60 (15.0%) patients (7/35 [20.0%] SPMS, 2/25 [8.0%] PPMS) and in 14/60 (23.3%) NC (p not significant for all comparisons). CCSVI criteria were fulfilled in 0 NC and 4 (6.7%) patients with MS: 3 SPMS and 1 PPMS. VGF, performed in 6/9 patients, was abnormal only in one case who had bilateral internal jugular vein stenosis.

CONCLUSION

Our findings indicate that CCSVI is not a late secondary phenomenon of MS and is not associated with disability.

摘要

目的

慢性脑脊髓静脉功能不全（CCSVI）被认为在多发性硬化症（MS）中起主要致病作用，但最近关于 MS 早期阶段的数据并未证实这一理论。然而，CCSVI 可能代表 MS 的晚期现象，或与残疾进展有关。因此，我们研究了原发性进展型（PP）和继发性进展型（SP）MS 中的 CCSVI 患病率，以明确 CCSVI 是否是这种疾病进展形式的特征。

方法

共纳入 35 例 SPMS 患者、25 例 PPMS 患者和 60 名年龄和性别匹配的正常对照者（NC）进行横断面研究。所有患者和 NC 均行颅外和颅内高分辨率静脉回声彩色多普勒超声（ECDS-TCDS）检查。对任何异常超声发现的患者进行选择性静脉造影（VGF）。

结果

PPMS 患者（11 名女性，14 名男性；平均年龄 47±11 岁）的病程为 11±7 年，扩展残疾状况量表（EDSS）评分为 6.0±0.5。SPMS 患者（22 名女性，13 名男性；平均年龄 45±14.5 岁）的病程为 18±14 年，EDSS 评分为 6.0±0.8。所有患者的 TCDS 均正常。ECDS 显示 9/60 例（15.0%）患者（7/35 例 [20.0%] SPMS，2/25 例 [8.0%] PPMS）和 14/60 例（23.3%）NC 存在 1 项或多项异常发现（所有比较的 p 均无显著性意义）。0 例 NC 和 4 例 MS 患者（3 例 SPMS 和 1 例 PPMS）符合 CCSVI 标准。对 6/9 例患者进行了 VGF，仅 1 例双侧颈内静脉狭窄患者异常。