Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
PLoS One. 2013 Aug 14;8(8):e72495. doi: 10.1371/journal.pone.0072495. eCollection 2013.
Multiple sclerosis (MS) is a chronic neurodegenerative disease of the CNS. Recently a controversial vascular hypothesis for MS, termed chronic cerebrospinal venous insufficiency (CCSVI), has been advanced. The objective of this study was to evaluate the relative prevalence of the venous abnormalities that define CCSVI.
A case-control study was conducted in which 100 MS patients aged between 18-65 y meeting the revised McDonald criteria were randomly selected and stratified into one of four MS subtypes: relapsing/remitting, secondary progressive, primary progressive and benign. Control subjects (16-70 y) with no known history of MS or other neurological condition were matched with the MS cases. All cases and controls underwent ultrasound imaging of the veins of the neck plus the deep cerebral veins, and magnetic resonance imaging of the neck veins and brain. These procedures were performed on each participant on the same day.
On ultrasound we found no evidence of reflux, stenosis or blockage in the internal jugular veins (IJV) or vertebral veins (VV) in any study participant. Similarly, there was no evidence of either reflux or cessation of flow in the deep cerebral veins in any subject. Flow was detected in the IJV and VV in all study participants. Amongst 199 participants there was one MS subject who fulfilled the minimum two ultrasound criteria for CCSVI. Using MRI we found no significant differences in either the intra- or extra-cranial venous flow velocity or venous architecture between cases and controls.
This case-control study provides compelling evidence against the involvement of CCSVI in multiple sclerosis.
多发性硬化症（MS）是一种中枢神经系统的慢性神经退行性疾病。最近，一种有争议的 MS 血管假说，即慢性脑脊髓静脉功能不全（CCSVI），已经提出。本研究的目的是评估定义 CCSVI 的静脉异常的相对流行率。
进行了一项病例对照研究，其中随机选择了 100 名年龄在 18-65 岁之间、符合修订后的 McDonald 标准的 MS 患者，并将其分为四个 MS 亚型之一：复发缓解型、继发进展型、原发进展型和良性型。对照组（16-70 岁）没有已知的 MS 或其他神经疾病史，与 MS 病例相匹配。所有病例和对照都接受了颈部和深部脑静脉的超声成像，以及颈部和脑静脉的磁共振成像。这些程序在同一天对每个参与者进行。
在超声检查中，我们没有发现任何研究参与者的颈内静脉（IJV）或椎静脉（VV）存在反流、狭窄或阻塞的证据。同样，在任何受试者中，深部脑静脉也没有反流或血流停止的证据。在所有研究参与者中，IJV 和 VV 都有血流。在 199 名参与者中，有一名 MS 患者符合 CCSVI 的最低两项超声标准。使用 MRI，我们在病例和对照组之间没有发现颅内或颅外静脉血流速度或静脉结构的显著差异。
这项病例对照研究提供了令人信服的证据，证明 CCSVI 与多发性硬化症无关。
