Suppr超能文献

多发性硬化症及各种相关脱髓鞘综合征的诊断:批判性评价。

The diagnosis of multiple sclerosis and the various related demyelinating syndromes: a critical review.

机构信息

Department of Neurology, Multiple Sclerosis Center and Laboratory of Neuroimmunology, The Agnes-Ginges Center for Neurogenetics, Hadassah University Hospital, Jerusalem, Ein-Kerem, Israel.

出版信息

J Autoimmun. 2014 Feb-Mar;48-49:134-42. doi: 10.1016/j.jaut.2014.01.022. Epub 2014 Feb 10.

Abstract

Multiple sclerosis (MS), is a chronic disease of the central nervous system (CNS) characterized by loss of motor and sensory function, that results from immune-mediated inflammation, demyelination and subsequent axonal damage. MS is one of the most common causes of neurological disability in young adults. Several variants of MS (and CNS demyelinating syndromes in general) have been nowadays defined in an effort to increase the diagnostic accuracy, to identify the unique immunopathogenic profile and to tailor treatment in each individual patient. These include the initial events of demyelination defined as clinically or radiologically isolated syndromes (CIS and RIS respectively), acute disseminated encephalomyelitis (ADEM) and its variants (acute hemorrhagic leukoencephalitis-AHL, Marburg variant, and Balo's concentric sclerosis), Schilder's sclerosis, transverse myelitis, neuromyelitis optica (NMO and NMO spectrum of diseases), recurrent isolated optic neuritis and tumefactive demyelination. The differentiation between them is not only a terminological matter but has important implications on their management. For instance, certain patients with MS and prominent immunopathogenetic involvement of B cells and autoantibodies, or with the neuromyelitic variants of demyelination, may not only not respond well but even deteriorate under some of the first-line treatments for MS. The unique clinical and neuroradiological features, along with the immunological biomarkers help to distinguish these cases from classical MS. The use of such immunological and imaging biomarkers, will not only improve the accuracy of diagnosis but also contribute to the identification of the patients with CIS or RIS who, are at greater risk for disability progression (worse prognosis) or, on the contrary, will have a more benign course. This review summarizes in a critical way, the diagnostic criteria (historical and updated) and the definitions/characteristics of MS of the various variants/subtypes of CNS demyelinating syndromes.

摘要

多发性硬化症(MS)是一种中枢神经系统(CNS)的慢性疾病,其特征是运动和感觉功能丧失,这是由免疫介导的炎症、脱髓鞘和随后的轴突损伤引起的。MS 是导致年轻人神经功能残疾的最常见原因之一。为了提高诊断准确性、识别独特的免疫发病机制特征,并为每位患者量身定制治疗方案,目前已经定义了几种 MS 变体(以及一般的 CNS 脱髓鞘综合征)。这些变体包括定义为临床或放射学孤立综合征(分别为 CIS 和 RIS)的脱髓鞘初始事件、急性播散性脑脊髓炎(ADEM)及其变体(急性出血性脑白质炎-AHL、马尔堡变体和巴洛同心性硬化症)、席尔德硬化症、横贯性脊髓炎、视神经脊髓炎(NMO 和 NMO 疾病谱)、复发性孤立性视神经炎和肿块样脱髓鞘。它们之间的区别不仅是一个术语问题,而且对它们的管理具有重要意义。例如,某些具有突出的 B 细胞和自身抗体免疫发病机制参与或具有脱髓鞘神经炎性变体的 MS 患者,不仅可能对某些一线 MS 治疗反应不佳,甚至可能恶化。独特的临床和神经影像学特征以及免疫生物标志物有助于将这些病例与经典 MS 区分开来。这些免疫和影像学生物标志物的使用不仅可以提高诊断的准确性,还可以帮助识别 CIS 或 RIS 患者,这些患者具有更大的残疾进展(预后较差)风险,或者相反,具有更良性的病程。本综述以批判性的方式总结了 CNS 脱髓鞘综合征的各种变体/亚型的诊断标准(历史和更新)和定义/特征。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验