Diem Lara, Bürge Maxine, Leichtle Alexander, Hakim Arsany, Chan Andrew, Salmen Anke, Evangelopoulos Maria-Eleptheria, Hoepner Robert
Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, 3010, Switzerland.
Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Ther Adv Neurol Disord. 2020 Dec 29;13:1756286420975909. doi: 10.1177/1756286420975909. eCollection 2020.
Blood-brain barrier dysfunction in active multiple sclerosis (MS) lesions leads to pathological changes of cerebrospinal fluid (CSF). Theoretically, CSF analyses could help to predict relapse recovery and the course of disability. In this monocentric study, we investigated the impact of CSF findings assessed during the first relapse of MS on the short-term course of disability.
We performed a retrospective observational study including MS patients with available CSF data after onset of first MS relapse. Clinical symptoms had to be accompanied by gadolinium-enhanced lesion on magnetic resonance imaging. Expanded Disability Status Scale (EDSS) assessments at timepoint of relapse and after relapse recovery were studied to analyze disability. A two-step multivariate linear regression analysis adjusted for EDSS at spinal tab, duration of symptoms, sex, time until post relapse EDSS assessment, immunotherapy post relapse, and relapse treatment with glucocorticoids/plasma exchange to predict relapse associated disability was run.
In the first step of the regression model, pathological albumin quotient (QAlb) [regression coefficient 0.50, 95% confidence interval (CI) (0.07-0.92), = 0.02, = 99] and CSF protein concentration [regression coefficient 0.84, 95% CI (0.33-1.35), = 0.001, = 99] predicted EDSS after relapse recovery. In the second step, the sum score of both predictors [range 0-2; per value: 0 ( = 73), 1 ( = 10), 2 ( = 15)] confirmed the negative impact on course of disability after relapse [regression coefficient 0.38, 95% CI (0.13-0.62), = 0.003, = 98]. In this final multivariate linear regression model ( < 0.001; 0.34), also EDSS at lumbar puncture [regression coefficient 0.58, 95% CI (0.35-0.81), < 0.001, = 98] and time between symptom onset and CSF evaluation [regression coefficient 0.03, 95% CI (0.006-0.048), = 0.01, = 98] forecast subsequent disability.
Our study conducted in MS patients during first relapse confirmed that both increased CSF protein concentration and pathological QAlb have a negative impact on EDSS after relapse. As secondary finding, we identified time from symptom onset to lumbar puncture as predictor of disability recovery after relapse.
活动性多发性硬化（MS）病灶中的血脑屏障功能障碍会导致脑脊液（CSF）的病理变化。从理论上讲，脑脊液分析有助于预测复发恢复情况和残疾进程。在这项单中心研究中，我们调查了MS首次复发时脑脊液检查结果对短期残疾进程的影响。
我们进行了一项回顾性观察性研究，纳入首次MS复发后有可用脑脊液数据的MS患者。临床症状必须伴有磁共振成像上的钆增强病灶。研究复发时和复发恢复后的扩展残疾状态量表（EDSS）评估，以分析残疾情况。进行了两步多元线性回归分析，对脊髓穿刺时的EDSS、症状持续时间、性别、复发后EDSS评估前的时间、复发后的免疫治疗以及糖皮质激素/血浆置换的复发治疗进行校正，以预测与复发相关的残疾情况。
在回归模型的第一步中，病理性白蛋白商（QAlb）[回归系数0.50，95%置信区间（CI）（0.07 - 0.92），P = 0.02，n = 99]和脑脊液蛋白浓度[回归系数0.84，95% CI（0.33 - 1.35），P = 0.001，n = 99]可预测复发恢复后的EDSS。在第二步中，两个预测因子的总分[范围0 - 2；每个值的数量：0（n = 73），1（n = 10），2（n = 15）]证实了对复发后残疾进程的负面影响[回归系数0.38，95% CI（0.13 - 0.62），P = 0.003，n = 98]。在这个最终的多元线性回归模型中（P < 0.001；R² = 0.34），腰椎穿刺时的EDSS[回归系数0.58，95% CI（0.35 - 0.81），P < 0.001，n = 98]和症状出现与脑脊液评估之间的时间[回归系数0.03，95% CI（0.006 - 0.048），P = 0.01，n = 98]也可预测随后出现的残疾情况。
我们在MS患者首次复发期间进行的研究证实，脑脊液蛋白浓度升高和病理性QAlb均对复发后的EDSS有负面影响。作为次要发现，我们确定从症状出现到腰椎穿刺的时间是复发后残疾恢复的预测指标。
