Department of Neurology (A.K., R.C.S., A.B., V.P., C.G., M.M., B.H.), Klinikum rechts der Isar, Medical Faculty, Technical University of Munich; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, Medical Faculty, Technical University of Munich; Max Planck Institute of Psychiatry (B.M.-M.), Munich; Department of Neuroradiology (C.Z.), Klinikum rechts der Isar, Medical Faculty, Technical University of Munich; TUM Neuroimaging Center (M.M.), Klinikum rechts der Isar, Medical Faculty, Technical University of Munich; and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany.
Neurol Neuroimmunol Neuroinflamm. 2019 May 30;6(4):e573. doi: 10.1212/NXI.0000000000000573. eCollection 2019 Jul.
To identify CSF parameters at diagnosis of clinically isolated syndrome (CIS) and MS that are associated with early inflammatory disease activity as measured by standardized cerebral MRI (cMRI).
One hundred forty-nine patients with newly diagnosed CIS and MS were included in the retrospective study. cMRI at onset and after 12 months was analyzed for T2 and gadolinium-enhancing lesions. CSF was tested for oligoclonal bands and intrathecal synthesis of immunoglobulin G (IgG), A (IgA), and M (IgM) before initiation of disease-modifying therapy (DMT). In a subgroup of patients, CSF and serum samples were analyzed for sCD27, neurofilament light chain, and IgG subclasses 1 and 3. Association between CSF parameters and cMRI activity was investigated by univariable and multivariable regression analysis in all patients, DMT-treated patients, and untreated patients.
IgG index, sCD27 levels in CSF, and to a lesser extent IgM index were associated with the occurrence of new cMRI lesions. IgG index and sCD27 levels in CSF were highly correlated. In a multivariable analysis, IgG index and to a lesser extent IgM index together with DMT treatment status and gender were strongest predictors of future cMRI activity.
CSF parameters such as IgG and IgM index are independently associated with future MRI activity and thus might be helpful to support early treatment decisions in patients newly diagnosed with CIS and MS.
确定在临床孤立综合征（CIS）和多发性硬化症（MS）的诊断中，与使用标准化脑部 MRI（cMRI）测量的早期炎症性疾病活动相关的 CSF 参数。
本回顾性研究纳入了 149 例新发 CIS 和 MS 患者。在发病时和 12 个月后分析 cMRI 上 T2 和钆增强病变。在开始使用疾病修正治疗（DMT）之前，对 CSF 进行寡克隆带和鞘内 IgG（IgG）、A（IgA）和 M（IgM）合成检测。在部分患者中，对 CSF 和血清样本进行 sCD27、神经丝轻链和 IgG 亚类 1 和 3 的分析。通过单变量和多变量回归分析，在所有患者、接受 DMT 治疗的患者和未接受治疗的患者中，调查 CSF 参数与 cMRI 活动之间的相关性。
IgG 指数、CSF 中的 sCD27 水平，以及在较小程度上的 IgM 指数与新的 cMRI 病变的发生相关。CSF 中的 IgG 指数和 sCD27 水平高度相关。在多变量分析中，IgG 指数和在较小程度上的 IgM 指数，以及 DMT 治疗状态和性别是未来 cMRI 活动的最强预测因素。
CSF 参数，如 IgG 和 IgM 指数，与未来 MRI 活动独立相关，因此可能有助于支持新诊断的 CIS 和 MS 患者的早期治疗决策。
