结构磁共振成像测量与多发性硬化症大样本真实世界队列患者的疲劳严重程度和持续性相关。

Structural MRI measures are associated with fatigue severity and persistence in a large, real-world cohort of people with multiple sclerosis.

机构信息

Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA/ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

出版信息

Mult Scler. 2024 May;30(6):738-746. doi: 10.1177/13524585241239473. Epub 2024 Mar 25.

DOI:10.1177/13524585241239473

PMID:38525561

Abstract

BACKGROUND

Results of research on radiological hallmarks of multiple sclerosis (MS) fatigue have been conflicting.

OBJECTIVE

To investigate the associations of lesion and brain compartment volumes with fatigue severity and persistence in people with multiple sclerosis (PwMS).

METHODS

The Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) network collects standardized data during routine care of PwMS from 10 healthcare institutions. Magnetic resonance imaging (MRI) predictors included baseline brain parenchymal (BPF) and gray matter fractions (GMF) and T2 lesion volume (T2LV). The Quality of Life in Neurological Disorders (Neuro-QOL) fatigue subscore was analyzed linearly and categorically using T-score cutpoints, with a period of elevated symptoms defined as T-score ⩾ mean + 0.5 SD over follow-up.

RESULTS

At baseline, of 4012 participants (average age: 45.6 ± 11.8 years; 73% female; 31% progressive MS), 2058 (51%) had no fatigue, 629 (16%) had mild fatigue, and 1325 (33%) had moderate-to-severe fatigue. One SD greater baseline BPF and GMF were associated with 0.83 ( < 0.001) and 0.38 ( = 0.02) lower values in the baseline Neuro-QOL fatigue T-score. A 1 SD lower log of total T2LV was associated with a 0.49 ( < 0.001) lower baseline fatigue T-score. Higher BPF and lower T2LV at baseline were associated with lower odds of subsequent periods of elevated fatigue.

CONCLUSION

Baseline lesion burden and lower generalized whole-brain volumes were associated with MS fatigue in cross-sectional and longitudinal analyses in a large, real-world cohort of PwMS.

摘要

背景

关于多发性硬化症（MS）疲劳的放射学特征的研究结果一直存在争议。

目的

探讨多发性硬化症患者（PwMS）的病灶和脑区容积与疲劳严重程度和持续性的相关性。

方法

多发性硬化症合作伙伴推进技术和健康解决方案（MS PATHS）网络在 10 家医疗机构对 PwMS 的常规护理期间收集标准化数据。磁共振成像（MRI）预测因子包括基线脑实质（BPF）和灰质分数（GMF）和 T2 病灶体积（T2LV）。使用 T 分数切点对生活质量在神经疾病中的表现（Neuro-QOL）疲劳子评分进行线性和分类分析，将症状升高的时间段定义为 T 分数 ⩾ 平均 + 0.5 SD 在随访期间。

结果

在基线时，4012 名参与者（平均年龄：45.6 ± 11.8 岁；73%为女性；31%为进展性 MS）中，2058 名（51%）无疲劳，629 名（16%）有轻度疲劳，1325 名（33%）有中重度疲劳。基线 BPF 和 GMF 每增加一个标准差，基线 Neuro-QOL 疲劳 T 分数分别降低 0.83（ < 0.001）和 0.38（ = 0.02）。总 T2LV 的对数每降低一个标准差，基线疲劳 T 分数就会降低 0.49（ < 0.001）。基线时 BPF 越低和 T2LV 越低，随后发生疲劳升高的时间段的可能性就越低。