早期多发性硬化症患者脊髓的微观结构损伤与修复及其与 5 年后残疾的相关性。
Microstructural Damage and Repair in the Spinal Cord of Patients With Early Multiple Sclerosis and Association With Disability at 5 Years.
机构信息
From the Department of Neuroradiology (M.G., E.B., J.-C.F.), Rennes University Hospital; Empenn (M.G., B.C., E.B., A.M., V.C., G.B., J.-C.F., A.K.), INRIA, Rennes University-CNRS-INSERM; Department of Neurology (L.M., E.L.P., G.E., A.K.), Rennes University Hospital; Paris Brain Institute (ICM) (B.S., B.B.), Sorbonne University-CNRS-INSERM; and Neurology Department (B.S., B.B.), APHP St Antoine Hospital, Paris, France.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2025 Jan;12(1):e200333. doi: 10.1212/NXI.0000000000200333. Epub 2024 Nov 21.
BACKGROUND AND OBJECTIVES
The dynamics of microstructural spinal cord (SC) damage and repair in people with multiple sclerosis (pwMS) and their clinical relevance have yet to be explored. We set out to describe patient-specific profiles of microstructural SC damage and change during the first year after MS diagnosis and to investigate their associations with disability and SC atrophy at 5 years.
METHODS
We performed a longitudinal monocentric cohort study among patients with relapsing-remitting MS: first relapse <1 year, no relapse <1 month, and high initial severity on MRI (>9 T2 lesions on brain MRI and/or initial myelitis). pwMS and age-matched healthy controls (HCs) underwent cervical SC magnetization transfer (MT) imaging at baseline and at 1 year for pwMS. Based on HC data, SC MT ratio -score maps were computed for each person with MS. An index of microstructural damage was calculated as the proportion of voxels classified as normal at baseline and identified as damaged after 1 year. Similarly, an index of repair was also calculated (voxels classified as damaged at baseline and as normal after 1 year). Linear models including these indices and disability or SC cross-sectional area (CSA) change between baseline and 5 years were implemented.
RESULTS
Thirty-seven patients and 19 HCs were included. We observed considerable variability in the extent of microstructural SC damage at baseline (0%-58% of SC voxels). We also observed considerable variability in damage and repair indices over 1 year (0%-31% and 0%-20%), with 18 patients showing predominance of damage and 18 predominance of repair. The index of microstructural damage was associated positively with the Expanded Disability Status Scale score ( = 0.504, = 0.002) and negatively with CSA change ( = -0.416, = 0.02) at 5 years, independent of baseline SC lesion volume.
DISCUSSION
People with early relapsing-remitting MS exhibited heterogeneous profiles of microstructural SC damage and repair. Progression of microstructural damage was associated with disability progression and SC atrophy 5 years later. These results indicate a potential for microstructural repair in the SC to prevent disability progression in pwMS.
背景与目的
多发性硬化症（MS）患者脊髓（SC）微观结构损伤和修复的动力学及其临床相关性尚未得到探索。我们旨在描述 MS 诊断后 1 年内患者 SC 微观结构损伤和变化的特定个体特征，并研究其与 5 年内残疾和 SC 萎缩的相关性。
方法
我们对复发性缓解型 MS 患者进行了一项纵向单中心队列研究：首次复发<1 年，无复发<1 个月，且 MRI 初始严重程度高（脑 MRI 上>9 个 T2 病变和/或初始脊髓炎）。MS 患者和年龄匹配的健康对照者（HCs）在基线和 1 年时进行颈段 SC 磁化传递（MT）成像。基于 HCs 数据，为每位 MS 患者计算了 SC MT 比得分图。微观结构损伤指数计算为基线时被归类为正常的体素比例，1 年后被归类为损伤的体素比例。同样，还计算了修复指数（基线时被归类为损伤的体素比例，1 年后被归类为正常的体素比例）。在包括这些指数和残疾或基线与 5 年之间 SC 横截面积（CSA）变化的线性模型中实施了这些指数。
结果
纳入了 37 名患者和 19 名 HCs。我们观察到基线时 SC 微观结构损伤的程度存在很大差异（0%-58%的 SC 体素）。我们还观察到 1 年内损伤和修复指数的变化也存在很大差异（0%-31%和 0%-20%），18 名患者以损伤为主，18 名患者以修复为主。微观结构损伤指数与扩展残疾状态量表评分呈正相关（ = 0.504， = 0.002），与 5 年时 CSA 变化呈负相关（ = -0.416， = 0.02），与基线时 SC 病变体积无关。
讨论
早期复发性缓解型 MS 患者表现出 SC 微观结构损伤和修复的异质性特征。微观结构损伤的进展与残疾进展和 5 年后 SC 萎缩有关。这些结果表明，SC 中存在微观结构修复的潜力，可以防止 MS 患者残疾进展。
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