Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Neuroimaging Core Facility, Innsbruck Medical University, Innsbruck, Austria.
Parkinsonism Relat Disord. 2019 Jan;58:23-27. doi: 10.1016/j.parkreldis.2018.08.004. Epub 2018 Aug 7.
The rate of clinical progression in patients with multiple system atrophy (MSA) varies between individuals and predictors for disease progression remain undefined. While the MSA-rasagiline study found no difference in the rates of clinical progression for patients treated with rasagiline versus placebo, it included a large, prospective magnetic resonance imaging (MRI) substudy that can provide new information on the underlying disease progression in patients with early MSA.
This post-hoc analysis compared the rate of clinical progression in patients with MSA-specific structural changes at baseline (MRI-positive group) versus the rate of progression in patients without evidence of such changes at baseline (MRI-negative group) using a repeated measures ANCOVA. Clinical progression was assessed using the Unified MSA Rating Scale (UMSARS) and Clinical Global Impression of Improvement (CGI-I).
Twenty-eight patients with early MSA of the parkinsonian subtype (MRI-positive n = 13; MRI-negative n = 15) who had complete baseline and follow-up UMSARS data were included in this analysis. Patients in the MRI-positive group had faster clinical progression from baseline to the end of the 48-week study compared with those in the MR-negative group as assessed by the UMSARS total (p = 0.028) and UMSARS motor (p = 0.008) scales. At week 48, MRI-positive patients also had a significantly worse health status vs. MRI-negative patients (p = 0.015).
This is the first study to demonstrate that MSA-specific abnormalities on structural MRI might represent a variant of MSA-P that is associated with more rapid progression and an overall worse prognosis.
多系统萎缩（MSA）患者的临床进展速度因人而异，目前仍未明确疾病进展的预测因素。尽管 MSA-雷沙吉兰研究发现，与安慰剂相比，接受雷沙吉兰治疗的患者在临床进展速度方面没有差异，但该研究包含了一项大型前瞻性磁共振成像（MRI）子研究，该研究可以为早期 MSA 患者的潜在疾病进展提供新信息。
本事后分析采用重复测量方差分析（ANCOVA）比较基线时具有 MSA 特异性结构改变的患者（MRI 阳性组）与基线时无此类改变证据的患者（MRI 阴性组）的临床进展速度。使用统一多系统萎缩评定量表（UMSARS）和临床总体印象改善量表（CGI-I）评估临床进展。
本分析纳入了 28 例帕金森亚型早期 MSA 患者（MRI 阳性组 n = 13；MRI 阴性组 n = 15），这些患者具有完整的基线和随访 UMSARS 数据。MRI 阳性组患者的 UMSARS 总分（p = 0.028）和 UMSARS 运动评分（p = 0.008）较 MRI 阴性组患者从基线到研究结束时的临床进展速度更快。在第 48 周，MRI 阳性患者的健康状况也明显差于 MRI 阴性患者（p = 0.015）。
这是第一项表明结构 MRI 上的 MSA 特异性异常可能代表 MSA-P 的一种变体，与更快速的进展和整体预后更差相关的研究。
