中国一项前瞻性研究：临床孤立综合征向多发性硬化症的进展预测因子。
Progression predictors of clinically isolated syndrome to multiple sclerosis: A prospective study in China.
机构信息
Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Neurology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
出版信息
Clin Neurol Neurosurg. 2024 Oct;245:108514. doi: 10.1016/j.clineuro.2024.108514. Epub 2024 Aug 17.
OBJECTIVES
Clinically isolated syndrome (CIS) is a preclinical phase of multiple sclerosis (MS). The progression rate of CIS to clinical definite MS (CDMS) varies significantly across different populations, and identifying predictors of progression is crucial for early diagnosis and treatment. We aimed to investigate predictors of progression from CIS to CDMS in a Chinese cohort.
METHODS
A single-center cohort study was conducted with newly diagnosed patients with CIS in China between 2018 and 2021. All patients underwent a comprehensive clinical evaluation, including neurological examination, magnetic resonance imaging, and laboratory tests. Follow-up assessments were conducted at regular intervals to monitor disease progression. Progression to CDMS was defined according to the 2017 McDonald criteria. Age, sex, Expanded Disability Status Scale (EDSS) score, number of patients with magnetic resonance imaging gadolinium-enhancing (Gd+) lesions, T2 lesions and Gd+ lesions count, CSF cell count, CSF total protein, CSF and serum neurofilament light chain (NfL), progranulin (PGRN) and Th17-related cytokines (IL-6, IL-17, IL-21, IL-22, IL-23 and TGF-β) were measured for association with risk of progression to CDMS.
RESULTS
A total of 96 CIS patients were recruited in the study. During the at least 24 months follow-up period, 57 (59.38 %) CIS patients progressed to CDMS, while 39 (40.62 %) patients without progression remained stable as CIS. Multivariate analysis revealed that younger age at onset (OR= 43.43, 95 % CI= 1.76-1071.68, p<0.021), higher CSF elevated protein (OR=58.64, 95 % CI=2.72-1264.51, p=0.009), higher CSF NfL levels (OR= 97.00, 95 % CI= 4.68-2012.99, p=0.003) and higher CSF IL-23 levels (OR= 412.02, 95 % CI=6.56-25869.60, p=0.004) were associated with high risk of progression to CDMS.
CONCLUSION
Younger age at onset, elevated CSF NfL, IL-23 and protein levels might be progression predictors of CIS to CDMS in Chinese population.
目的
临床孤立综合征（CIS）是多发性硬化症（MS）的临床前阶段。CIS 向临床确诊多发性硬化症（CDMS）的进展速度在不同人群中差异很大，因此识别进展的预测因素对于早期诊断和治疗至关重要。我们旨在研究中国队列中 CIS 向 CDMS 进展的预测因素。
方法
这是一项在中国进行的单中心队列研究，纳入了 2018 年至 2021 年期间新诊断的 CIS 患者。所有患者均接受了全面的临床评估，包括神经系统检查、磁共振成像和实验室检查。定期进行随访评估以监测疾病进展。根据 2017 年 McDonald 标准定义 CDMS 的进展。年龄、性别、扩展残疾状况量表（EDSS）评分、磁共振成像钆增强（Gd+）病变患者数量、T2 病变和 Gd+病变计数、脑脊液细胞计数、脑脊液总蛋白、脑脊液和血清神经丝轻链（NfL）、颗粒蛋白聚糖（PGRN）和 Th17 相关细胞因子（IL-6、IL-17、IL-21、IL-22、IL-23 和 TGF-β）用于与进展为 CDMS 的风险相关联。
结果
本研究共纳入 96 例 CIS 患者。在至少 24 个月的随访期间，57 例（59.38%）CIS 患者进展为 CDMS，而 39 例（40.62%）无进展的患者仍为 CIS 稳定期。多变量分析显示，发病年龄较小（OR=43.43，95%CI=1.76-1071.68，p<0.021）、脑脊液升高蛋白（OR=58.64，95%CI=2.72-1264.51，p=0.009）、脑脊液 NfL 水平较高（OR=97.00，95%CI=4.68-2012.99，p=0.003）和脑脊液 IL-23 水平较高（OR=412.02，95%CI=6.56-25869.60，p=0.004）与向 CDMS 进展的高风险相关。
结论
在中国人群中，发病年龄较小、脑脊液 NfL、IL-23 和蛋白水平升高可能是 CIS 向 CDMS 进展的预测因素。
Zotero 插件