动态残疾测量法减少了严重多发性硬化症患者的临床-放射学差距。

Dynamic disability measures decrease the clinico-radiological gap in people with severely affected multiple sclerosis.

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.

Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.

出版信息

Mult Scler Relat Disord. 2024 Jul;87:105630. doi: 10.1016/j.msard.2024.105630. Epub 2024 Apr 22.

DOI:10.1016/j.msard.2024.105630

PMID:38678969

Abstract

BACKGROUND

Expanded Disability Status Scale (EDSS) is limited when utilized in highly disabled people with multiple sclerosis (pwMS).

OBJETIVE

To explore the relationship between disability measures and MRI outcomes in severely-affected pwMS.

METHODS

PwMS recruited from The Boston Home (TBH), a specialized residential facility for severly-affected pwMS and University at Buffalo (UB) MS Center were assessed using EDSS, MS Severity Scale, age-related MSS, Scripps Neurological Rating Scale (SNRS) and Combinatorial Weight-Adjusted Disability Score (CombiWISE). In all scores except SNRS, higher score indicates greater disability. MRI measures of T1, T2-lesion volume (LV), whole brain, gray matter, medulla oblongata and thalamic volumes (WBV, GMV, MOV, TV) and thalamic dysconnectivity were obtained.

RESULTS

Greatest disability differences between the TBH and UB pwMS were in SNRS (24.4 vs 71.9, p < 0.001, Cohen's d = 4.05) and CombiWISE (82.3 vs. 38.9, p < 0.001, Cohen's d = 4.02). In combined analysis of all pwMS, worse SNRS scores were correlated with worse MRI pathology in 8 out of 9 outcomes. EDSS only with 3 measures (GMV, MOV and TV). In severely-affected pwMS, SNRS was associated with T1-LV, T2-LV and WBV (not surviving false discovery rate (FDR) correction for multiple comparisons) whereas EDSS did not.

CONCLUSION

Granular and dynamic disability measures may bridge the clinico-radiologcal gap present in severely affected pwMS.

摘要

背景

扩展残疾状况量表（EDSS）在多发性硬化症（MS）重度残疾患者中应用有限。

目的

探讨严重 MS 患者残疾评估与 MRI 结果的关系。

方法

从波士顿疗养院（TBH）和布法罗大学（UB）MS 中心招募严重 MS 患者，采用 EDSS、MS 严重程度量表、年龄相关 MSS、斯克里普斯神经学评定量表（SNRS）和组合加权调整残疾评分（CombiWISE）进行评估。除 SNRS 外，其他评分越高表明残疾程度越严重。获取 T1、T2 病灶体积（LV）、全脑、灰质、延髓和丘脑体积（WBV、GMV、MOV、TV）及丘脑失连接的 MRI 测量值。

结果

TBH 和 UB 组 MS 患者之间 SNRS（24.4 分比 71.9 分，p<0.001，Cohen's d=4.05）和 CombiWISE（82.3 分比 38.9 分，p<0.001，Cohen's d=4.02）的残疾差异最大。所有 MS 患者的综合分析显示，SNRS 评分越差，9 项 MRI 病理结果中有 8 项越差。EDSS 仅与 3 项指标（GMV、MOV 和 TV）相关。在重度 MS 患者中，SNRS 与 T1-LV、T2-LV 和 WBV 相关（未通过 FDR 校正多重比较的错误发现率），而 EDSS 不相关。