Revesz T, Kidd D, Thompson A J, Barnard R O, McDonald W I
Department of Neuropathology, Institute of Neurology, London, UK.
Brain. 1994 Aug;117 ( Pt 4):759-65. doi: 10.1093/brain/117.4.759.
The dynamics of primary progressive multiple sclerosis differ from those of the more common secondary progressive form. The observation by MRI that the frequency of enhancement with gadolinium-DTPA, a marker for blood-brain barrier dysfunction, is significantly less in the primary progressive form, has led to the hypothesis that inflammation is less intense in this group. To test this, we have studied postmortem material from nine cases judged from a retrospective analysis of case notes to show clear clinical evidence of either primary progressive or secondary progressive disease. Five hundred and seventy-eight lesions were analysed. There was significantly more inflammation in secondary progressive multiple sclerosis (as judged by the frequency of perivascular cuffing and cellularity of the parenchyma) than in primary progressive disease. These observations have implications for therapeutic strategies in progressive multiple sclerosis.
原发性进行性多发性硬化的病程与更常见的继发性进行性形式不同。通过磁共振成像观察到，作为血脑屏障功能障碍标志物的钆喷酸葡胺增强频率在原发性进行性形式中显著较低，这导致了一种假设，即该组炎症程度较轻。为了验证这一点，我们研究了9例尸检材料，这些病例通过对病历的回顾性分析判断，显示出原发性进行性或继发性进行性疾病的明确临床证据。分析了578个病灶。继发性进行性多发性硬化中的炎症（根据血管周围套袖形成频率和实质细胞性判断）明显多于原发性进行性疾病。这些观察结果对进行性多发性硬化的治疗策略具有启示意义。
