脉络丛体积的动态变化与多发性硬化症中疲劳的存在和发展相关。
Dynamics of choroid plexus volume is associated with the presence and development of fatigue in multiple sclerosis.
作者信息
Rubin Martina, Preziosa Paolo, Margoni Monica, Meani Alessandro, Pagani Elisabetta, Corazzolla Gianluca, Storelli Loredana, Mistri Damiano, Filippi Massimo, Rocca Maria A
机构信息
Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy.
Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy.
出版信息
J Neurol Neurosurg Psychiatry. 2025 Apr 10;96(5):443-452. doi: 10.1136/jnnp-2024-334913.
BACKGROUND
Immune-mediated processes are implicated in the pathogenesis of fatigue, a common symptom in multiple sclerosis (MS). The choroid plexus (CP) regulates central nervous system (CNS) immune homeostasis and undergoes volumetric modifications possibly contributing to MS-related fatigue. We explored the association between MS-related CP volume changes and fatigue dynamics.
METHOD
Eighty-five patients with MS and 68 healthy controls (HC) underwent brain 3T MRI, neurological evaluation and Modified Fatigue Impact Scale (MFIS) at two timepoints (median follow-up=1.4 years). Normalised brain and regional grey matter (GM) volumes were obtained using FSL-SIENAx, FIRST, SIENA and tensor-based morphometry. CP volumes were quantified with in-house methods, and longitudinal changes were analysed using linear mixed models.
RESULTS
At baseline, 25 (29%) patients with MS had fatigue (f-MS) (MFIS ≥38). Compared with HC, patients with MS had significantly higher brain T2-lesion volume, lower brain, deep GM, cortical volumes and higher CP volume (false discovery rate (FDR)-p ≤0.024). Compared with non-fatigued (nf-MS) patients, f-MS were older, more disabled (FDR-p ≤0.002) and showed numerically higher CP volume (FDR-p=0.076). At follow-up, 41 (68%) nf-MS remained non-fatigued (nf-FU-MS) and 19 (32%) developed fatigue (f-FU-MS). Patients with MS showed higher brain and deep GM atrophy rates versus HC (FDR-p ≤0.048), whereas clinical, lesional and brain volumetric changes were not significantly different among MS groups (FDR-p ≥0.287). CP volume significantly increased in all MS groups compared with HC (FDR-p ≤0.043), with greater enlargement in f-FU-MS versus nf-FU-MS (FDR-p=0.048).
CONCLUSIONS
Larger CP and greater enlargement are associated with the presence and development of fatigue in MS, likely reflecting dynamic inflammatory states within the CNS, supporting the immunological contribution to MS-related fatigue.
背景
免疫介导过程与疲劳的发病机制有关，疲劳是多发性硬化症（MS）的常见症状。脉络丛（CP）调节中枢神经系统（CNS）的免疫稳态，并发生体积变化，这可能与MS相关的疲劳有关。我们探讨了MS相关的CP体积变化与疲劳动态之间的关联。
方法
85例MS患者和68名健康对照（HC）在两个时间点（中位随访时间 = 1.4年）接受了脑部3T MRI、神经学评估和改良疲劳影响量表（MFIS）评估。使用FSL-SIENAx、FIRST、SIENA和基于张量的形态计量学获得标准化的脑和区域灰质（GM）体积。CP体积采用内部方法进行量化，并使用线性混合模型分析纵向变化。
结果
在基线时，25例（29%）MS患者有疲劳症状（f-MS）（MFIS≥38）。与HC相比，MS患者的脑T2病变体积显著更高，脑、深部GM、皮质体积更低，CP体积更高（错误发现率（FDR）-p≤0.024）。与无疲劳症状（nf-MS）的患者相比，f-MS患者年龄更大，残疾程度更高（FDR-p≤0.002），CP体积在数值上更高（FDR-p = 0.076）。在随访时，41例（68%）nf-MS患者仍无疲劳症状（nf-FU-MS），19例（32%）出现疲劳症状（f-FU-MS）。与HC相比，MS患者的脑和深部GM萎缩率更高（FDR-p≤0.048），而MS组之间的临床、病变和脑体积变化无显著差异（FDR-p≥0.287）。与HC相比，所有MS组的CP体积均显著增加（FDR-p≤0.043），f-FU-MS组的CP体积增大幅度大于nf-FU-MS组（FDR-p = 0.048）。
结论
更大的CP体积和更大的增大幅度与MS患者疲劳症状的存在和发展相关，可能反映了CNS内的动态炎症状态，支持免疫因素对MS相关疲劳的影响。
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