Dastagir Akram, Healy Brian C, Chua Alicia S, Chitnis Tanuja, Weiner Howard L, Bakshi Rohit, Tauhid Shahamat
Departments of Neurology and Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, USA.
Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
eNeurologicalSci. 2018 Jul 4;12:42-46. doi: 10.1016/j.ensci.2018.07.002. eCollection 2018 Sep.
Primary progressive (PP) multiple sclerosis (MS) is considered a clinically distinct entity from the spectrum of relapsing-remitting (RR) forms of the disease.
To compare the presence of brain and spinal cord lesions between PP and RR subjects.
We studied people with PPMS [ = 40, 17 (42.5%) men, age 50.7 ± 7.7 years, disease duration 10.1 ± 7.4 years, Expanded Disability Status Scale (EDSS) score 4.6 ± 2.1] and RRMS [ = 40, 12 (30%) men, age 47.9 ± 4.2, disease duration 13.7 ± 5.9, EDSS 1.7 ± 1.3]. MRI of the brain and full spinal cord at 1.5T was analyzed to define patients having: 1. brain only, 2. spinal cord only, or 3. brain and spinal cord MS lesions.
Lesions in the brain only were less common in PP ( = 1, 2.5% of people) than RR ( = 10, 25%) (Fisher's exact = 0.007). Lesions in the spinal cord only (PP: = 6, 15%, RR: = 3, 7.5%, = 0.481) or brain plus spinal cord (PP: = 33, 83%, RR: = 27, 68%, = 0.196) were similar between groups. PP had higher EDSS and timed 25-ft walk (Wilcoxon tests, both < 0.001), higher age (-test = 0.049), lower disease duration (-test, = 0.02), and a similar sex ratio (Fisher's exact = 0.352) vs. RR.
We report a topographic difference in MRI lesion involvement between PPMS and RRMS. Lesions restricted to the brain are more common in RRMS. These findings provide support to the notion that PP may have features distinctive from the RR spectrum of the disease. Longitudinal comparisons and quantitative MRI analysis would be necessary to confirm and extend these results.
原发性进展型（PP）多发性硬化（MS）被认为是一种在临床上与复发缓解型（RR）疾病谱不同的实体。
比较PP和RR受试者脑和脊髓病变的情况。
我们研究了PPMS患者[=40例，17例（42.5%）男性，年龄50.7±7.7岁，病程10.1±7.4年，扩展残疾状态量表（EDSS）评分4.6±2.1]和RRMS患者[=40例，12例（30%）男性，年龄47.9±4.2岁，病程13.7±5.9年，EDSS 1.7±1.3]。对1.5T的脑部和全脊髓MRI进行分析，以确定患者有：1.仅脑部病变；2.仅脊髓病变；或3.脑部和脊髓MS病变。
仅脑部病变在PP患者中（=1例，占患者的2.5%）比RR患者中（=10例，占25%）少见（Fisher精确检验=0.007）。仅脊髓病变（PP：=6例，占15%，RR：=3例，占7.5%，=0.481）或脑部加脊髓病变（PP：=33例，占83%，RR：=27例，占68%，=0.196）在两组之间相似。与RR相比，PP的EDSS和25英尺步行时间更长（Wilcoxon检验，均<0.001），年龄更大（t检验=0.049），病程更短（t检验，=0.02），性别比例相似（Fisher精确检验=0.352）。
我们报告了PPMS和RRMS在MRI病变累及部位上的差异。局限于脑部的病变在RRMS中更常见。这些发现支持了PP可能具有与RR疾病谱不同特征的观点。需要进行纵向比较和定量MRI分析来证实和扩展这些结果。
