Neurology, University Hospital Ghent, Gent, Belgium
Neurology, University Hospital Ghent, Gent, Belgium.
J Neurol Neurosurg Psychiatry. 2024 Oct 16;95(11):1021-1031. doi: 10.1136/jnnp-2023-333307.
It remains unclear whether routine cerebrospinal fluid (CSF) parameters can serve as predictors of multiple sclerosis (MS) disease course.
This large-scale cohort study included persons with MS with CSF data documented in the MSBase registry. CSF parameters to predict time to reach confirmed Expanded Disability Status Scale (EDSS) scores 4, 6 and 7 and annualised relapse rate in the first 2 years after diagnosis (ARR2) were assessed using (cox) regression analysis.
In total, 11 245 participants were included of which 93.7% (n=10 533) were persons with relapsing-remitting MS (RRMS). In RRMS, the presence of CSF oligoclonal bands (OCBs) was associated with shorter time to disability milestones EDSS 4 (adjusted HR=1.272 (95% CI, 1.089 to 1.485), p=0.002), EDSS 6 (HR=1.314 (95% CI, 1.062 to 1.626), p=0.012) and EDSS 7 (HR=1.686 (95% CI, 1.111 to 2.558), p=0.014). On the other hand, the presence of CSF pleocytosis (≥5 cells/µL) increased time to moderate disability (EDSS 4) in RRMS (HR=0.774 (95% CI, 0.632 to 0.948), p=0.013). None of the CSF variables were associated with time to disability milestones in persons with primary progressive MS (PPMS). The presence of CSF pleocytosis increased ARR2 in RRMS (adjusted R=0.036, p=0.015).
In RRMS, the presence of CSF OCBs predicts shorter time to disability milestones, whereas CSF pleocytosis could be protective. This could however not be found in PPMS. CSF pleocytosis is associated with short-term inflammatory disease activity in RRMS. CSF analysis provides prognostic information which could aid in clinical and therapeutic decision-making.
目前尚不清楚常规脑脊液 (CSF) 参数是否可作为多发性硬化症 (MS) 病程的预测指标。
本大规模队列研究纳入了 MSBase 注册中心记录有 CSF 数据的 MS 患者。使用（Cox）回归分析评估 CSF 参数预测达到确诊扩展残疾状况量表（EDSS）评分 4、6 和 7 的时间以及诊断后前 2 年的年复发率（ARR2）。
共纳入 11245 名参与者，其中 93.7%（n=10533）为复发缓解型多发性硬化症（RRMS）患者。在 RRMS 中，CSF 寡克隆带（OCB）的存在与残疾里程碑 EDSS 4（调整后的 HR=1.272（95%CI，1.089 至 1.485），p=0.002）、EDSS 6（HR=1.314（95%CI，1.062 至 1.626），p=0.012）和 EDSS 7（HR=1.686（95%CI，1.111 至 2.558），p=0.014）的时间缩短相关。另一方面，CSF 白细胞增多（≥5 个细胞/μL）增加了 RRMS 中中度残疾（EDSS 4）的时间（HR=0.774（95%CI，0.632 至 0.948），p=0.013）。在原发性进展型多发性硬化症（PPMS）患者中，没有 CSF 变量与残疾里程碑时间相关。CSF 白细胞增多与 RRMS 的 ARR2 增加相关（调整后的 R=0.036，p=0.015）。
在 RRMS 中，CSF OCB 的存在可预测残疾里程碑的时间缩短，而 CSF 白细胞增多可能具有保护作用。但在 PPMS 中并未发现这种情况。CSF 白细胞增多与 RRMS 的短期炎症疾病活动相关。CSF 分析提供了预后信息，有助于临床和治疗决策。
