顺磁环病变预示着在 10 年内更大的长期复发率和临床进展。

Paramagnetic rim lesions predict greater long-term relapse rates and clinical progression over 10 years.

机构信息

Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.

Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.

出版信息

Mult Scler. 2024 Apr;30(4-5):535-545. doi: 10.1177/13524585241229956. Epub 2024 Feb 17.

DOI:10.1177/13524585241229956

PMID:38366920

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11009059/

Abstract

BACKGROUND

Paramagnetic rim lesions (PRLs) have been linked to higher clinical disease severity and relapse frequency. However, it remains unclear whether PRLs predict future, long-term disease progression.

OBJECTIVES

The study aimed to assess whether baseline PRLs were associated with subsequent long-term (10 years) Expanded Disability Status Scale (EDSS) increase and relapse frequency and, if so, whether PRL-associated EDSS increase was mediated by relapse.

METHODS

This retrospective analysis included 172 people with multiple sclerosis (pwMS) with 1868 yearly clinical visits over a mean follow-up time of 10.2 years. 3T magnetic resonance imaging (MRI) was acquired at baseline and PRLs were assessed on quantitative susceptibility mapping (QSM) images. The associations between PRLs, relapse, and rate of EDSS change were assessed using linear models.

RESULTS

PRL+ pwMS had greater overall annual relapse rate (β = 0.068; = 0.010), three times greater overall odds of relapse (exp(β) = 3.472; = 0.009), and greater rate of yearly EDSS change (β = 0.045; = 0.010) than PRL- pwMS. Greater PRL number was associated with greater odds of at least one progression independent of relapse activity (PIRA) episode over follow-up (exp(β) = 1.171, = 0.009). Mediation analysis showed that the association between PRL presence (yes/no) and EDSS increase was 96.7% independent of relapse number.

CONCLUSION

PRLs are a marker of aggressive ongoing disease inflammatory activity, including more frequent future clinical relapses and greater long-term, relapse-independent disability progression.

摘要

背景

顺磁环样病灶（PRLs）与更高的临床疾病严重程度和复发频率相关。然而，PRLs 是否能预测未来的长期疾病进展尚不清楚。

目的

本研究旨在评估基线 PRLs 是否与随后的长期（10 年）扩展残疾状态量表（EDSS）增加和复发频率相关，如果是，PRL 相关的 EDSS 增加是否通过复发来介导。

方法

这项回顾性分析纳入了 172 名多发性硬化症（pwMS）患者，他们在平均 10.2 年的随访期间进行了 1868 次年度临床随访。在基线时采集了 3T 磁共振成像（MRI），并在定量磁化率映射（QSM）图像上评估 PRLs。使用线性模型评估 PRLs、复发和 EDSS 变化率之间的关联。

结果

PRL+ pwMS 的总体年复发率更高（β=0.068；=0.010），总体复发的可能性是 PRL- pwMS 的三倍（exp（β）=3.472；=0.009），EDSS 每年的变化率也更高（β=0.045；=0.010）。PRL 数量越多，与随访期间至少一次独立于复发活动的进展事件（PIRA）的可能性就越大（exp（β）=1.171；=0.009）。中介分析表明，PRL 存在（是/否）与 EDSS 增加之间的关联有 96.7%是独立于复发次数的。