Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
Department of Laboratory Medicine, University Hospital Brno, Brno, Czech Republic.
Mult Scler Relat Disord. 2022 Jul;63:103847. doi: 10.1016/j.msard.2022.103847. Epub 2022 May 6.
Intrathecal IgM synthesis has been identified as an adverse prognostic factor in patients with multiple sclerosis (MS); however, some studies have not confirmed this association. The objective of this study was to evaluate the clinical utility of intrathecal IgM synthesis for prediction of disease activity and disability in patients after the first demyelinating event of MS.
We conducted a single-centre prospective observational cohort study at the Department of Neurology, University Hospital Ostrava, Czech Republic. Intrathecal IgM synthesis was demonstrated by the presence of cerebrospinal fluid-restricted oligoclonal IgM bands and calculated using the Reiber, Auer, and Öhman formula and IgM index.
A total of 61 patients with a clinically isolated syndrome or early relapsing-remitting MS were enrolled into the analysis of which 37 (61 %) were women. The median age at the disease onset was 32 years (interquartile range [IQR] 25 - 42), and the median disease duration was 2.8 years (IQR 2.4 - 3.5). Thirty-eight (62 %) patients experienced a second relapse of MS with a median of 312 days (IQR 192 - 424), and 29 (47.5 %) developed magnetic resonance imaging (MRI) activity during the follow-up. Intrathecal IgM synthesis did not affect the risk of a second relapse or evidence of MRI activity in univariate and multivariate Cox regression analysis. There was no significant difference in disability using the Expanded Disability Status Scale and progression index in patients with or without intrathecal IgM synthesis.
This prospective cohort study did not demonstrate that intrathecal IgM synthesis is a risk factor for a second relapse or MRI activity. It was not associated with higher disability in patients after the first demyelinating event.
鞘内 IgM 合成已被确定为多发性硬化症（MS）患者的预后不良因素；然而，一些研究并未证实这种关联。本研究的目的是评估鞘内 IgM 合成对预测 MS 首次脱髓鞘事件后患者疾病活动和残疾的临床应用价值。
我们在捷克奥斯特拉瓦大学医院神经科进行了一项单中心前瞻性观察队列研究。通过存在脑脊液受限的寡克隆 IgM 带并使用 Reiber、Auer 和 Öhman 公式和 IgM 指数来证明鞘内 IgM 合成。
共有 61 例临床孤立综合征或早期复发缓解型 MS 患者纳入分析，其中 37 例（61%）为女性。疾病发病时的中位年龄为 32 岁（四分位距 [IQR] 25-42），中位病程为 2.8 年（IQR 2.4-3.5）。38 例（62%）患者发生 MS 第二次复发，中位时间为 312 天（IQR 192-424），29 例（47.5%）在随访期间出现 MRI 活动。单变量和多变量 Cox 回归分析显示，鞘内 IgM 合成不影响第二次复发或 MRI 活动的风险。在有无鞘内 IgM 合成的患者中，扩展残疾状态量表和进展指数的残疾程度无显著差异。
这项前瞻性队列研究并未表明鞘内 IgM 合成是第二次复发或 MRI 活动的危险因素。它与首次脱髓鞘事件后患者的更高残疾无关。
