Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.
Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
Mult Scler. 2020 Oct;26(11):1372-1380. doi: 10.1177/1352458519863781. Epub 2019 Jul 18.
To compare the performance of the 2017 McDonald criteria with that of the 2010 criteria for the diagnosis of multiple sclerosis (MS) in children in the clinical setting.
In this retrospective, multi-centre study, we identified children who presented with symptoms suggestive of a clinically isolated syndrome (CIS) and were followed up for at least 2 years or until their second attack.
Of 156 children with CIS followed up for a median of 4.17 years, 94 (60.3%) were diagnosed with MS. In all, 83 (88.3%) of these fulfilled the 2010 dissemination in space (DIS) criteria at onset. Three additional children fulfilled the 2017 DIS criteria because of the inclusion of symptomatic lesions. Of the 59 children with MS who underwent post-gadolinium magnetic resonance imaging (MRI), 44 (74.6%) fulfilled the 2010 dissemination in time (DIT) criteria at baseline. When the presence of oligoclonal bands (OCBs) was used to substitute DIT, an additional 35 children (79/94, 84.0%) were diagnosed with MS according to the 2017 criteria. The 2017 criteria had higher accuracy (87.2% vs 66.7%), higher sensitivity (84.0% vs 46.8%), but reduced specificity (91.9% vs 96.8%) when compared to the 2010 criteria.
The improved performance of the 2017 criteria when compared to the 2010 criteria was predominantly due to the inclusion of intrathecal OCBs.
比较 2017 年 McDonald 标准与 2010 年标准在儿童临床多发性硬化（MS）诊断中的性能。
在这项回顾性、多中心研究中，我们鉴定了具有临床孤立综合征（CIS）表现并至少随访 2 年或直到发生第二次发作的儿童。
在中位随访 4.17 年的 156 例 CIS 患儿中，94 例（60.3%）诊断为 MS。这些患儿中，83 例（88.3%）在发病时符合 2010 年弥散空间（DIS）标准。由于包括症状性病变，另外 3 例符合 2017 年 DIS 标准。在 59 例行钆增强磁共振成像（MRI）的 MS 患儿中，44 例（74.6%）在基线时符合 2010 年弥散时间（DIT）标准。当使用寡克隆带（OCB）来替代 DIT 时，根据 2017 年标准，另外 35 例患儿（94 例中的 79 例，84.0%）被诊断为 MS。与 2010 年标准相比，2017 年标准的准确性更高（87.2% vs 66.7%），敏感性更高（84.0% vs 46.8%），但特异性降低（91.9% vs 96.8%）。
与 2010 年标准相比，2017 年标准性能的提高主要归因于鞘内 OCB 的纳入。
