Bi C F, Qian H R, Peng L J, Mao L L, Huang X, Xia D Y, Lei X, Qi X K
Navy Clinical College of Anhui Medical University, Department of Neurology, Navy General Hospital of PLA, Beijing 100048, China.
Zhonghua Nei Ke Za Zhi. 2016 Jun;55(6):460-5. doi: 10.3760/cma.j.issn.0578-1426.2016.06.012.
To analyze the features of patients who converted from clinically isolated syndrome (CIS) to multiple sclerosis (MS) and neuromyelitis optica (NMO) and explore the correlated factors.
A total of 151 patients admitted in our unit as CIS from January 2009 to December 2014 were enrolled in the study. All patients were divided into the following four groups by locations of the initial lesion, which were the spinal cord, the optic nerve, the brain stem and the multifocal lesions. Data were collected at the baseline including demographics, expanded disability status scale (EDSS) score, site of CIS, presence or absence of cerebrospinal fluid (CSF) oligoclonal bands (OB) and serum aquaporin-4 antibody (AQP4-Ab), evoked potential (EP) and MRI lesions. The conversion rates from CIS to clinically definite MS or NMO were calculated and the correlated factors were explored.
With a mean follow-up period of (44.11±17.62)months, 46/151(30.5%) patients converted to MS, 28/151 (18.5%) to definite NMO and 66/151 patients(43.7%)remained as CIS. Other patients were converted to optic neuritis(4/151), one-time transverse myelitis(3/151), acute disseminated encephalomyelitis (1/151) and Balo concentric sclerosis(3/151) . The EDSS score was significantly higher in patients converted to NMO than those converted to MS (P=0.003). The initial manifestation of optic neuritis significantly correlated with the conversion to NMO (P=0.000), while the initial manifestation of CIS with multifocal lesions significantly correlated with the conversion to MS (P=0.000). Neither the isolated BAEP (P=0.703), VEP (P=0.076), SEP (P=0.915) nor the combination of two (P=0.546)or three (P=1.000) of the above parameters could help to distinguish the conversion to MS or NMO. More patients with positive CSF-OB converted to MS (P=0.001), while more patients with positive serum AQP4-Ab converted to NMO (P=0.001). More patients were serum AQP4-Ab positive in those converted to NMO than those converted to MS (P=0.000). Lesions longer than three vertebral segments were dominant in patients converted to NMO (P=0.000). The logistic regression analysis revealed that factors correlated with conversion from CIS to MS were the initial CIS manifestation of multifocal lesions (OR=4.775, P=0.002), positive CSF-OB (OR=7.794, P=0.002) and VEP abnormality (OR=7.251, P=0.001). Factors correlated with conversion from CIS to NMO were female in gender (OR=12.536, P=0.019), positive serum AQP4-Ab (OR=36.410, P=0.002), lesions longer than three vertebral segments (OR=93.602, P=0.001), abnormal VEP and SEP (OR=18.448, P=0.002; OR=12.731, P=0.016).
Factors correlated with the conversion from CIS to MS are initial CIS manifestation of multifocal lesions, positive CSF-OB and abnormal VEP, while those correlated with the conversion from CIS to NMO are female in gender, positive serum AQP4-Ab, initial CIS manifestation with optic nerve, lesions involved more than three vertebral segments and abnormal VEP and SEP.
分析临床孤立综合征（CIS）转化为多发性硬化（MS）和视神经脊髓炎（NMO）患者的特征，并探讨相关因素。
选取2009年1月至2014年12月在我科收治的151例CIS患者纳入研究。所有患者根据首发病灶部位分为以下四组，即脊髓、视神经、脑干和多灶性病变组。收集基线数据，包括人口统计学资料、扩展残疾状态量表（EDSS）评分、CIS部位、脑脊液（CSF）寡克隆带（OB）及血清水通道蛋白4抗体（AQP4-Ab）的有无、诱发电位（EP）和MRI病灶情况。计算CIS转化为临床确诊MS或NMO的转化率，并探讨相关因素。
平均随访时间为（44.11±17.62）个月，46/151（30.5%）例患者转化为MS，28/151（18.5%）例转化为确诊NMO，66/151例患者（43.7%）仍为CIS。其他患者分别转化为视神经炎（4/151）、一次性横贯性脊髓炎（3/151）、急性播散性脑脊髓炎（1/151）和巴洛同心圆性硬化（3/151）。转化为NMO的患者EDSS评分显著高于转化为MS的患者（P=0.003）。视神经炎首发表现与转化为NMO显著相关（P=0.000），而多灶性病变的CIS首发表现与转化为MS显著相关（P=0.000）。孤立的脑干听觉诱发电位（BAEP，P=0.703））视觉诱发电位（VEP，P=0.076）、体感诱发电位（SEP，P=0.915）以及上述两项（P=
