Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Beijing, 100070, China.
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Neurotherapeutics. 2021 Apr;18(2):868-877. doi: 10.1007/s13311-020-00973-9. Epub 2021 Jan 19.
Gadolinium (Gd)-contrast MRI for reliable detection of blood-brain barrier (BBB) breakdown is widely used in neuromyelitis optica spectrum disorder (NMOSD) attack. Nonetheless, little is known about the predictive role of gadolinium-enhancing lesion in prognosis of NMOSD attack. The aim of this work is to investigate the predictive value of persistently Gd-enhanced lesions to medium-term outcome after attack. Data for this analysis came from an ongoing prospective cohort study (CLUE). NMOSD patients with acute attack were enrolled from January 2019 to March 2020. All patients underwent Gd-contrast MRI at baseline and 1 month, and disability was assessed by Expanded Disability Status Scale (EDSS). Primary outcome was EDSS improvement from baseline to month 6. Multiple logistic regression identified predictors for poor recovery of NMOSD attack. Forty-one participants were analyzed, of which 21 patients had persistently Gd-enhancing lesions. Patients in no enhancement (NE) group showed a significant shift in 6-month EDSS distributions compared with those in persistent enhancement (PE) group (p = 0.005). Poor recovery rate of the PE group was higher than that of the NE group at 6 months (p = 0.033). In patients with aquaporin-4-positive, first-attack, transverse myelitis or in a high-dose steroid treatment subgroup, the improvement of EDSS scores in the PE group was still less compared with that in the NE group (p < 0.05). The presence of persistently Gd-enhancing lesion appears to be associated with poor recovery after attack (OR = 5.473, p = 0.014). Our study found that persistently gadolinium-enhancing lesion is a poor prognosis predictor after NMOSD attack. Trial registration ID: NCT04106830.
钆对比磁共振成像（Gd-MRI）广泛用于视神经脊髓炎谱系疾病（NMOSD）发作时可靠地检测血脑屏障（BBB）破坏，但目前对于 Gd 增强病变在 NMOSD 发作预后中的预测作用知之甚少。本研究旨在探讨发作后持续 Gd 增强病变对中期预后的预测价值。这项分析的数据来自一项正在进行的前瞻性队列研究（CLUE）。2019 年 1 月至 2020 年 3 月期间，招募了急性发作的 NMOSD 患者。所有患者在基线和 1 个月时均行 Gd-MRI 检查，并采用扩展残疾状况量表（EDSS）评估残疾程度。主要结局是从基线到 6 个月时 EDSS 的改善情况。多因素逻辑回归分析确定了 NMOSD 发作恢复不良的预测因素。分析了 41 名参与者，其中 21 名患者存在持续的 Gd 增强病变。与无增强（NE）组相比，持续增强（PE）组 6 个月 EDSS 分布有显著变化（p=0.005）。6 个月时，PE 组的恢复不良率高于 NE 组（p=0.033）。在抗水通道蛋白 4 阳性、首次发作、横贯性脊髓炎或高剂量激素治疗亚组中，PE 组 EDSS 评分的改善仍低于 NE 组（p<0.05）。持续 Gd 增强病变的存在与 NMOSD 发作后恢复不良相关（OR=5.473，p=0.014）。我们的研究发现，NMOSD 发作后持续 Gd 增强病变是预后不良的预测因素。试验注册编号：NCT04106830。
