Habek Mario, Krbot Skorić Magdalena, Crnošija Luka, Gabelić Tereza, Barun Barbara, Adamec Ivan
School of Medicine, University of Zagreb, Zagreb, Croatia.
Eur Neurol. 2017;77(5-6):253-257. doi: 10.1159/000469707. Epub 2017 Apr 5.
BACKGROUND/AIMS: There have been suggestions that interactions exist between the autonomic nervous system (ANS) and the immune system functions in multiple sclerosis (MS). We aimed to evaluate the ANS dysfunction, more specifically postural orthostatic tachycardia syndrome (POTS), as a possible predictor of conversion to MS in patients with clinically isolated syndrome (CIS).
In this observational, prospective, longitudinal study, 84 patients were enrolled (56 females, mean age 32.9 ± 8.9 years). Disease activity during a 6-month period was monitored (relapses and/or MRI disease activity indicated by new T2 or T1 enhancing lesions), and the following predictors analyzed: age, Expanded Disability Status Scale, MRI midbrain, pontine or medulla oblongata lesions, and POTS on the head up tilt test.
POTS was identified in 8 (9.5%) patients. Of 84 patients, 62 (73.8%) completed the 6-month follow-up, and 28 (45.2%) patients converted to MS. Results of the multivariate regression analysis revealed age (10-year increase) and POTS as significant predictors of early conversion to MS (OR 2.34, 95% CI 1.15-4.78, p = 0.019 and OR 12.40, 95% CI 1.13-136.62, p = 0.040). The logistic model was statistically significant, χ2 (6) = 13.885, p = 0.031.
POTS may be an indicator of a more active disease course in CIS patients and possibly be used as a prognostic factor.
背景/目的：有观点认为自主神经系统（ANS）与多发性硬化症（MS）的免疫系统功能之间存在相互作用。我们旨在评估ANS功能障碍，更具体地说是体位性直立性心动过速综合征（POTS），作为临床孤立综合征（CIS）患者转化为MS的可能预测指标。
在这项观察性、前瞻性、纵向研究中，纳入了84例患者（56例女性，平均年龄32.9±8.9岁）。监测6个月期间的疾病活动情况（复发和/或新的T2或T1强化病灶所显示的MRI疾病活动），并分析以下预测指标：年龄、扩展残疾状态量表、MRI中脑、脑桥或延髓病变，以及头高位倾斜试验中的POTS。
8例（9.5%）患者被诊断为POTS。84例患者中，62例（73.8%）完成了6个月的随访，28例（45.2%）患者转化为MS。多因素回归分析结果显示，年龄（每增加10岁）和POTS是早期转化为MS的显著预测指标（OR 2.34，95%CI 1.15 - 4.78，p = 0.019；OR 12.40，95%CI 1.13 - 136.62，p = 0.040）。逻辑模型具有统计学意义，χ2（6）= 13.885，p = 0.031。
POTS可能是CIS患者疾病进程更活跃的一个指标，并且可能用作预后因素。
