Bsteh Gabriel, Hegen Harald, Altmann Patrick, Auer Michael, Berek Klaus, Di Pauli Franziska, Haider Lukas, Kornek Barbara, Krajnc Nik, Leutmezer Fritz, Macher Stefan, Rommer Paulus, Walchhofer Lisa-Maria, Zebenholzer Karin, Zulehner Gudrun, Deisenhammer Florian, Pemp Berthold, Berger Thomas
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Eur J Neurol. 2023 Apr;30(4):1025-1034. doi: 10.1111/ene.15718. Epub 2023 Feb 16.
This study was undertaken to investigate baseline peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell and inner plexiform layer (GCIPL) thickness for prediction of disability accumulation in early relapsing multiple sclerosis (RMS).
From a prospective observational study, we included patients with newly diagnosed RMS and obtained spectral-domain optical coherence tomography scan within 90 days after RMS diagnosis. Impact of pRNFL and GCIPL thickness for prediction of disability accumulation (confirmed Expanded Disability Status Scale [EDSS] score ≥ 3.0) was tested by multivariate (adjusted hazard ratio [HR] with 95% confidence interval [CI]) Cox regression models.
We analyzed 231 MS patients (mean age = 30.3 years, SD = 8.1, 74% female) during a median observation period of 61 months (range = 12-93). Mean pRNFL thickness was 92.6 μm (SD = 12.1), and mean GCIPL thickness was 81.4 μm (SD = 11.8). EDSS ≥ 3 was reached by 28 patients (12.1%) after a median 49 months (range = 9-92). EDSS ≥ 3 was predicted with GCIPL < 77 μm (HR = 2.7, 95% CI = 1.6-4.2, p < 0.001) and pRNFL thickness ≤ 88 μm (HR = 2.0, 95% CI = 1.4-3.3, p < 0.001). Higher age (HR = 1.4 per 10 years, p < 0.001), incomplete remission of first clinical attack (HR = 2.2, p < 0.001), ≥10 magnetic resonance imaging (MRI) lesions (HR = 2.0, p < 0.001), and infratentorial MRI lesions (HR = 1.9, p < 0.001) were associated with increased risk of disability accumulation, whereas highly effective disease-modifying treatment was protective (HR = 0.6, p < 0.001). Type of first clinical attack and presence of oligoclonal bands were not significantly associated.
Retinal layer thickness (GCIPL more than pRNFL) is a useful predictor of future disability accumulation in RMS, independently adding to established markers.
本研究旨在调查早期复发型多发性硬化症（RMS）患者的基线视乳头周围视网膜神经纤维层（pRNFL）厚度以及黄斑神经节细胞和内丛状层（GCIPL）厚度，以预测残疾累积情况。
在一项前瞻性观察性研究中，我们纳入了新诊断为RMS的患者，并在RMS诊断后90天内进行了频域光学相干断层扫描。通过多变量（调整后的风险比[HR]及95%置信区间[CI]）Cox回归模型，测试pRNFL和GCIPL厚度对残疾累积（确认的扩展残疾状态量表[EDSS]评分≥3.0）预测的影响。
我们分析了231例MS患者（平均年龄 = 30.3岁，标准差 = 8.1，74%为女性），中位观察期为六个月（范围 = 12 - 93个月）。平均pRNFL厚度为92.6μm（标准差 = 12.1），平均GCIPL厚度为81.4μm（标准差 = 11.8）。28例患者（12.1%）在中位49个月（范围 = 9 - 92个月）后达到EDSS≥3。GCIPL厚度<77μm（HR = 2.7，95% CI = 1.6 - 4.2，p < 0.001）和pRNFL厚度≤88μm（HR = 2.0，95% CI = 1.4 - 3.3，p < /span>.001）可预测EDSS≥3。年龄较大（每10年HR = 1.4，p < 0.001）、首次临床发作未完全缓解（HR = 2.2，p < 0.001）、≥10个磁共振成像（MRI）病灶（HR = 2.0，p < 0.001）和幕下MRI病灶（HR = 1.9，p < 0.001）与残疾累积风险增加相关，而高效的疾病修饰治疗具有保护作用（HR = 0.6，p < 0.001）。首次临床发作类型和寡克隆带的存在无显著相关性。
视网膜层厚度（GCIPL比pRNFL更具预测价值）是RMS未来残疾累积的有用预测指标，独立于已有的标志物增加了预测信息。
