Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands/Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.
Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.
Mult Scler. 2020 Oct;26(11):1381-1391. doi: 10.1177/1352458519864933. Epub 2019 Aug 2.
The objective of the study was to determine whether early infratentorial and/or spinal cord lesions are long-term cumulative predictors of disability progression in multiple sclerosis (MS).
We selected 153 MS patients from the longitudinal Amsterdam MS cohort. Lesion analysis was performed at baseline and year 2. Disability progression after 6 and 11 years was measured using the Expanded Disability Status Scale (EDSS) and EDSS-plus (including 25-foot walk and 9-hole peg test). Patients with spinal cord or infratentorial lesions were compared for the risk of 6- and 11-year disability progression to patients without spinal cord or infratentorial lesions, respectively. Subsequently, patients with lesions on both locations were compared to patients with only spinal cord or only infratentorial lesions.
Baseline spinal cord lesions show a higher risk of 6-year EDSS progression (odds ratio (OR): 3.6, = 0.007) and EDSS-plus progression (OR: 2.5, = 0.028) and 11-year EDSS progression (OR: 2.8, = 0.047). Patients with both infratentorial and spinal cord lesions did not have a higher risk of 6-year disability progression than patients with only infratentorial or only spinal cord lesions.
The presence of early spinal cord lesions seems to be a dominant risk factor of disability progression. Simultaneous presence of early infratentorial and spinal cord lesions did not undisputedly predict disability progression.
本研究旨在确定早期小脑和/或脊髓病变是否是多发性硬化症（MS）残疾进展的长期累积预测因素。
我们从阿姆斯特丹 MS 纵向队列中选择了 153 名 MS 患者。在基线和第 2 年进行病变分析。使用扩展残疾状况量表（EDSS）和 EDSS-plus（包括 25 英尺步行和 9 孔钉测试）测量 6 年和 11 年后的残疾进展。将有脊髓或小脑病变的患者与无脊髓或小脑病变的患者分别进行比较，以评估他们发生 6 年和 11 年残疾进展的风险。随后，将同时存在两处病变的患者与仅存在脊髓或仅存在小脑病变的患者进行比较。
基线脊髓病变显示出更高的 6 年 EDSS 进展风险（优势比（OR）：3.6， = 0.007）和 EDSS-plus 进展风险（OR：2.5， = 0.028）以及 11 年 EDSS 进展风险（OR：2.8， = 0.047）。同时存在小脑和脊髓病变的患者与仅存在小脑或仅存在脊髓病变的患者相比，6 年残疾进展的风险并没有更高。
早期脊髓病变的存在似乎是残疾进展的主要危险因素。早期小脑和脊髓病变同时存在并不能明确预测残疾进展。
