Multiple Sclerosis Unit, Neurology Service, Hospital Universitari i Politècnic La Fe, Bulevar Sur s/n, 46026 Valencia, Spain.
Eur J Radiol. 2012 Nov;81(11):3485-90. doi: 10.1016/j.ejrad.2012.01.028. Epub 2012 Mar 4.
To assess the evolution of brain atrophy and its relationship with inflammatory activity in RRMS patients treated with natalizumab.
Eighteen RRMS patients were prospectively followed up for 18 months after starting natalizumab therapy. Patients were monitored monthly and assessed for signs of relapses, adverse events or disability increase. MRI scans were performed before starting natalizumab and every six months. Cross-sectional T2 lesion volume (T2LV) and the normalized brain volume (NBV) at baseline and 18 months MRI scans were calculated using the Steronauta® and SIENAx softwares, respectively. Longitudinal Percentage of Brain Volume Change (PBVC) was estimated with SIENA. Linkage between inflammatory activity and brain atrophy was studied.
Natalizumab reduced ARR by 67% and cumulative CEL by 87.5%. T2 lesion volume decreased from 1000 mm3, to 960 mm3 (p=0.006) and NBV decreased from 1.55×10(5) mm3 to 1.42×10(5) mm3 (p=0.025). Global PBVC from baseline to 18 months was -2.5%, predominantly during the first six months (0-6 months PBVC -1.7%; 6-12 months PBVC -0.74%; 12-18 months PBVC -0.50%). The number of relapses before treatment was correlated to the PBVC during the first semester (Pearson's coefficient -0.520, p=0.003), while the number of basal CEL or baseline T2LV did not correlate with brain atrophy rate. During follow-up, nine patients had clinical or radiological inflammatory activity. Their PBVC was significantly higher in the first semester (-2.3% to -1.1%, p=0.002).
Natalizumab reduced relapse rate and CEL in MRI. Brain atrophy predominated in the first semester and was related to previous inflammatory activity.
评估接受那他珠单抗治疗的 RRMS 患者脑萎缩的演变及其与炎症活动的关系。
18 例 RRMS 患者在开始那他珠单抗治疗后进行了 18 个月的前瞻性随访。患者每月接受监测并评估复发、不良事件或残疾加重的迹象。在开始那他珠单抗治疗前和每 6 个月进行 MRI 扫描。使用 Steronauta®和 SIENAx 软件分别计算基线和 18 个月 MRI 扫描的横截面 T2 病变体积（T2LV）和标准化脑体积（NBV）。使用 SIENA 估计纵向脑容量变化百分比（PBVC）。研究炎症活动与脑萎缩之间的联系。
那他珠单抗使 ARR 降低了 67%，使累积 CEL 降低了 87.5%。T2 病变体积从 1000mm3 减少到 960mm3（p=0.006），NBV 从 1.55×10(5)mm3 减少到 1.42×10(5)mm3（p=0.025）。从基线到 18 个月的全球 PBVC 为-2.5%，主要发生在前 6 个月（0-6 个月 PBVC-1.7%；6-12 个月 PBVC-0.74%；12-18 个月 PBVC-0.50%）。治疗前的复发次数与前半学期的 PBVC 相关（Pearson 系数-0.520，p=0.003），而基线 T2LV 或基线 CEL 数量与脑萎缩率无关。在随访期间，9 名患者出现临床或影像学炎症活动。他们在前半学期的 PBVC 明显更高（-2.3%至-1.1%，p=0.002）。
那他珠单抗降低了复发率和 MRI 中的 CEL。脑萎缩主要发生在前半学期，与先前的炎症活动有关。
