Gajamange Sanuji, Stankovich Jim, Egan Gary, Kilpatrick Trevor, Butzkueven Helmut, Fielding Joanne, van der Walt Anneke, Kolbe Scott
Department of Medicine and Radiology, University of Melbourne, Australia.
Department of Neuroscience, Central Clinical School, Monash University, Australia.
Mult Scler J Exp Transl Clin. 2019 Jul 23;5(3):2055217319863122. doi: 10.1177/2055217319863122. eCollection 2019 Jul-Sep.
Biomarkers are urgently required for predicting the likely progression of multiple sclerosis (MS) at the earliest stages of the disease to aid in personalised therapy.
We aimed to examine early brain volumetric and microstructural changes and retinal nerve fibre layer thinning as predictors of longer term MS severity in patients with clinically isolated syndromes (CIS).
Lesion metrics, brain and regional atrophy, diffusion fractional anisotropy and retinal nerve fibre layer thickness were prospectively assessed in 36 patients with CIS over the first 12 months after presentation and compared with clinical outcomes at longer term follow-up [median (IQR) = 8.5 (7.8-8.9) years].
In total, 25 (69%) patients converted to MS and had greater baseline lesion volume ( = 0.008) and number ( = 0.03)than CIS patients. Over the initial 12 months, new lesions ( = 0.0001), retinal nerve fibre layer thinning ( = 0.04) and ventricular enlargement ( = 0.03) were greater in MS than CIS patients. In MS patients, final Expanded Disability Status Scale score correlated with retinal nerve fibre layer thinning over the first 12 months (ρ = -0.67, = 0.001).
Additional to lesion metrics, early measurements of fractional anisotropy and retinal nerve fibre layer thinning are informative about longer term clinical outcomes in CIS.
迫切需要生物标志物来在多发性硬化症（MS）疾病的最早阶段预测其可能的进展，以辅助个性化治疗。
我们旨在研究早期脑容量和微观结构变化以及视网膜神经纤维层变薄情况，作为临床孤立综合征（CIS）患者MS长期严重程度的预测指标。
对36例CIS患者在就诊后的前12个月内前瞻性评估病变指标、脑和区域萎缩、扩散分数各向异性以及视网膜神经纤维层厚度，并与长期随访[中位数（IQR）=8.5（7.8 - 8.9）年]时的临床结果进行比较。
共有25例（69%）患者转变为MS，其基线病变体积（=0.008）和数量（=0.03）均大于CIS患者。在最初的12个月内，MS患者的新病变（=0.0001）、视网膜神经纤维层变薄（=0.04）和脑室扩大（=0.03）情况均比CIS患者更严重。在MS患者中，最终扩展残疾状态量表评分与最初12个月内的视网膜神经纤维层变薄相关（ρ=-0.67，=0.001）。
除病变指标外，早期测量分数各向异性和视网膜神经纤维层变薄情况有助于了解CIS患者的长期临床结果。
