Zheng Yang, Shen Chun-Hong, Wang Sa, Yang Fan, Cai Meng-Ting, Fang Wei, Zhang Yin-Xi, Ding Mei-Ping
Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Neurology, First People's Hospital of Wenling, Wenling, China.
Ther Adv Neurol Disord. 2020 Jan 20;13:1756286419898083. doi: 10.1177/1756286419898083. eCollection 2020.
Diagnostic criteria for multiple sclerosis have evolved over time, with the most recent being the 2017 McDonald criteria. Evidence is lacking regarding the validity of the 2017 McDonald criteria among the Asian population. Therefore, this study aims to evaluate the diagnostic performance of the 2017 McDonald criteria in Chinese patients with clinically isolated syndrome (CIS).
A total of 93 patients with initial findings suggestive of CIS in a tertiary hospital in China from 2012 to 2017 were included in this retrospective study. Baseline and follow-up data were reviewed. Diagnostic performance (sensitivity, specificity, accuracy), was assessed and survival analysis was performed for the 2017 and 2010 McDonald criteria respectively.
Among the 93 Chinese patients with CIS, 57 were female (61.3%) and the median (interquartile range) age of onset was 37 (31.3-41.8) years. The 2017 McDonald criteria displayed a higher sensitivity (75.0% 14.6%, < 0.0001), lower specificity (47.1% 100.0%, < 0.05) but an overall higher accuracy (67.7% 36.9%, < 0.0001) when compared with the 2010 iteration. The novel criteria allow for a better detection of MS at baseline (40.8% 9.9%, < 0.0001).
The 2017 McDonald criteria had a higher sensitivity but lower specificity than the 2010 iteration. Overall it facilitated an earlier and more accurate diagnosis of multiple sclerosis in Chinese patients with CIS.
多发性硬化症的诊断标准随时间不断演变，最新的是2017年麦克唐纳标准。目前缺乏关于2017年麦克唐纳标准在亚洲人群中有效性的证据。因此，本研究旨在评估2017年麦克唐纳标准对中国临床孤立综合征（CIS）患者的诊断效能。
本回顾性研究纳入了2012年至2017年在中国一家三级医院初诊提示为CIS的93例患者。回顾了基线和随访数据。分别对2017年和2010年麦克唐纳标准的诊断效能（敏感性、特异性、准确性）进行评估并进行生存分析。
在93例中国CIS患者中，57例为女性（61.3%），发病年龄中位数（四分位间距）为37（31.3 - 41.8）岁。与2010年版本相比，2017年麦克唐纳标准显示出更高的敏感性（75.0%对14.6%，<0.0001）、更低的特异性（47.1%对100.0%，<0.05），但总体准确性更高（67.7%对36.9%，<0.0001）。新的标准能够在基线时更好地检测出多发性硬化症（40.8%对9.9%，<0.0001）。
2017年麦克唐纳标准比2010年版本具有更高的敏感性但更低的特异性。总体而言，它有助于对中国CIS患者更早、更准确地诊断多发性硬化症。
