Department of Neurology, Weill Cornell Medicine, New York, New York, USA.
Department of Mathematics and Statistics, Cleveland State University, Cleveland, Ohio, USA.
Ann Clin Transl Neurol. 2024 Nov;11(11):2923-2931. doi: 10.1002/acn3.52203. Epub 2024 Sep 17.
Black American (BA) multiple sclerosis (MS) patients experience greater disability compared to White American (WA) patients. Here, we investigated the role of paramagnetic rim lesions (PRLs), a subset of chronic active lesions, on race-related disability in MS.
We conducted a retrospective observational study comparing BA and WA MS patients. PRLs were identified through Quantitative Susceptibility Mapping (QSM) MRI. A causal mediation analysis explored the impact of PRLs on the relationship between race and disability, as measured by the Expanded Disability Status Scale (EDSS).
The prevalence of PRLs in BA patients with MS was higher at 55% compared to WA patients at 39% (p = 0.022). A higher percentage of PRLs among all white matter lesions was observed with BA (8.01%) patients compared to WA (3.4%) patients (p = 0.003). In a regression analysis, controlling for significant patient-level covariates and income-level demographics, the percentage of PRLs was, on average, 4.61 points higher for BA patients than for WA patients (p = 0.003). In a separate regression analysis, accounting for covariates, BA patients exhibited significantly higher EDSS scores (p < 0.001). Further analysis demonstrated that the percentage of PRLs was a mediator in the association between BA patients and greater disability (p = 0.031). Higher proportion of PRLs in BA population accounted for 14% of the total effect of race on disability.
BA patients exhibit greater disability, in part, due to their higher proportion of PRLs. This study underscores the substantial impact of chronic active lesions on disability outcomes in this specific minority MS patient population.
与美国白人（WA）多发性硬化症（MS）患者相比，美国黑人（BA）MS 患者的残疾程度更高。在此，我们研究了慢性活动性病变亚组——顺磁性边缘病灶（PRLs）在 MS 种族相关残疾中的作用。
我们进行了一项回顾性观察性研究，比较了 BA 和 WA MS 患者。通过定量磁化率映射（QSM）MRI 识别 PRLs。因果中介分析探讨了 PRLs 对残疾评估量表（EDSS）测量的种族与残疾之间关系的影响。
BA 患者 MS 中 PRLs 的患病率为 55%，高于 WA 患者的 39%（p=0.022）。BA 患者的所有脑白质病变中 PRLs 的比例更高（8.01%），而 WA 患者的比例较低（3.4%）（p=0.003）。在回归分析中，控制了有意义的患者水平协变量和收入水平人口统计学因素，BA 患者的 PRLs 比例平均比 WA 患者高 4.61 分（p=0.003）。在单独的回归分析中，考虑到协变量，BA 患者的 EDSS 评分显著更高（p<0.001）。进一步分析表明，PRLs 的比例是 BA 患者和残疾程度更高之间关联的中介（p=0.031）。BA 人群中 PRLs 的比例较高，占种族对残疾总效应的 14%。
BA 患者表现出更大的残疾程度，部分原因是其 PRLs 比例较高。这项研究强调了慢性活动性病变对这一特定少数民族 MS 患者群体残疾结局的重大影响。
