视神经炎后预测多发性硬化症的预后模型的建立：视神经炎治疗试验数据的二次分析。

Development of a Prognostic Model for Predicting Multiple Sclerosis After Optic Neuritis: A Secondary Analysis of Data From the Optic Neuritis Treatment Trial.

机构信息

Department of Neurology (WL), the First Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Environmental Health Sciences (XD), University at Albany, State University of New York, Rensselaer, New York; State Key Laboratory of Ophthalmology (XX), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Department of Ophthalmology (RS, ML, YD), the First Affiliated Hospital of Guangxi Medical University, Nanning, China; Byers Eye Institute (HEM), Stanford University, Palo Alto, California; and Department of Neurology and Neurological Sciences (HEM), Stanford University, Stanford, California.

出版信息

J Neuroophthalmol. 2022 Mar 1;42(1):88-96. doi: 10.1097/WNO.0000000000001424. Epub 2021 Oct 22.

DOI:10.1097/WNO.0000000000001424

PMID:34860745

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9159903/

Abstract

BACKGROUND

Optic neuritis can be the initial manifestation of multiple sclerosis (MS). The purpose of this study was to develop a prognostic model for predicting the risk of MS development among patients with optic neuritis.

METHODS

The data from 388 patients with optic neuritis were retrieved from the Optic Neuritis Treatment Trial (ONTT). Cox proportional hazards regression analysis was used to develop a prognostic model. The performance of the model was assessed by using Harrell's C-index and calibration curves. The rates of MS development were estimated using the Kaplan-Meier method.

RESULTS

Among the enrolled subjects, a total of 154 (39.7%) patients developed clinically definite MS during a median follow-up period of 15.8 years (interquartile range, 7.2-16.9 years). The factors associated with the development of MS were the presence of brain lesions as on baseline MRI, previous nonspecific neurologic symptoms, commencing low-dose corticosteroids treatment, ocular pain, and absence of optic disc/peripapillary hemorrhage. After incorporating these 5 factors into the prognostic model, a C-index of 0.72 (95% confidence interval [CI], 0.69-0.76) and good calibration curves were obtained. The C-index of the model was significantly higher than the C-indexes of any single factor (P < 0.001 in all cases). The model was able to stratify the ONTT patient cohort into 3 risk groups with significantly different intergroup rates of developing MS (rates for developing MS within a 15-year period: high-risk group, 75.7% [95% CI, 65.6%-82.9%], intermediate-risk group, 44.7% [95% CI, 31.4%-55.4%]; and low-risk group, 20.8% [95% CI, 14.2%-26.8%]; log-rank P < 0.001).

CONCLUSIONS

This prognostic model had a better prediction ability when compared with the standard practice that relies solely on using brain lesions on MRI. It can, therefore, help guide decision-making to initiate earlier disease-modifying therapy for patients with optic neuritis at risk of developing MS.

摘要

背景

视神经炎可作为多发性硬化症（MS）的首发表现。本研究旨在建立一种预测视神经炎患者发生 MS 风险的预后模型。

方法

从视神经炎治疗试验（ONTT）中检索到 388 例视神经炎患者的数据。采用 Cox 比例风险回归分析建立预后模型。采用 Harrell's C 指数和校准曲线评估模型性能。采用 Kaplan-Meier 法估计 MS 发生率。

结果

在纳入的受试者中，共有 154 例（39.7%）患者在中位随访 15.8 年（四分位距，7.2-16.9 年）期间发生临床确诊的 MS。与 MS 发生相关的因素包括基线 MRI 上存在脑病变、既往非特异性神经系统症状、开始低剂量皮质类固醇治疗、眼部疼痛和视盘/视乳头周围无出血。将这 5 个因素纳入预后模型后，得到了 0.72（95%置信区间 [CI]，0.69-0.76）的 C 指数和良好的校准曲线。该模型的 C 指数明显高于任何单一因素的 C 指数（所有情况下 P < 0.001）。该模型能够将 ONTT 患者队列分为 3 个风险组，各组间 MS 发生率有显著差异（15 年内发生 MS 的发生率：高危组为 75.7%[95%CI，65.6%-82.9%]，中危组为 44.7%[95%CI，31.4%-55.4%]；低危组为 20.8%[95%CI，14.2%-26.8%]；对数秩检验 P < 0.001）。