Neurology:多发性硬化患者发病年龄与灰质体积和白质微结构异常的关系

2021-10-19 Naomii MedSci原创

年轻患者最初对多发性硬化症相关损害具有一定的补偿性,随后补偿机制开始失效,WM完整性丧失,接着是GM萎缩,最后是残疾。

     多发性硬化症(MS)的临床病程与年龄有关。研究潜在病理生理学的有效模型是比较儿童起病(18岁前)(POMS)和成人起病(AOMS)患者,包括一段中枢神经系统活动和免疫系统成熟期,将年龄效应发挥到极致。与AOMS相比,POMS患者在发病头几年具有更高的炎症活动度和更好的临床恢复能力。他们需要更长的病程才会造成一定程度的残疾,但在更年轻的岁数就能达到,并显示出认知效率更快的恶化。从病理生理学的角度来看,POMS患者表现出高度的炎症和轴突丢失,但也增强了髓鞘的再形成和神经可塑性。

     在一项先前的研究发现,在POMS与疾病持续时间(DD)匹配的AOMS患者中,早期损伤更具破坏性,但灰质(GM)保存更好,尽管后期残疾程度较低,但GM萎缩和白质(WM)损害更严重。另一项研究发现,与年龄和DD匹配的AOMS患者相比,POMS患者的WM损害更严重。这些和其他研究的局限性是在调整其他变量时年龄或DD的混杂影响。 近日,有研究探讨了发病年龄对成人多发性硬化(MS)患者脑灰质体积(GMV)和白质(WM)微结构异常的影响及其对临床表型和病程的影响。

     

     在这项假设驱动的横断面研究中,共招募了67名儿童首发多发性硬化症(POMS)患者和143名性别和病程(DD)匹配的成年多发性硬化症(AOMS)患者,以及208名健康对照者。

     所有受试者均接受神经学评估和3T磁共振成像。MRI变量以健康对照组为基础进行标准化,以消除年龄和性别的影响。用线性模型研究POMS、AOMS患者与DD的关系。用产品限制法评估达到临床和MRI里程碑的时间。

  • 在DD=1年时,AOMS患者GMV和WM分数各向异性(FA)均异常,而POMS患者GMV和WM分数各向异性(FA)无异常。
  • 在GMV和WM FA中,发病年龄(POMS和AOMS)与DD之间存在显著的交互作用。POMS和AOMS患者回归线的交叉点分别为GMV DD 20年和WM FA 14年。
  • 对于POMS和AOMS患者,达到扩展残疾状态量表=3的中位DD分别为29岁和19岁(P<0.001),达到异常起搏听觉序列相加任务3的中位DD分别为31岁和26岁(P=0.01),达到GMV异常的中位DD分别为24岁和18岁(P=0.04),达到WM FA异常的中位DD分别为19岁和17岁(P=0.36)。

     年轻患者最初对多发性硬化症相关损害具有一定的补偿性,随后补偿机制开始失效,白质完整性丧失,接着是脑灰质萎缩,最后是残疾。

文献来源:https://n.neurology.org/content/early/2021/10/04/WNL.0000000000012869.long

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    2022-04-17 jml2009
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    2022-02-24 yinhl1978
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本研究结果表明,吸烟和被动吸烟都会对多发性硬化症产生负面影响,确诊后戒烟可能是一项重要的二级预防措施。

2023年美国神经病学学会新兴科学年会| 外周血基因表达转录分析可预测原发进展型多发性硬化症的病情进展

转录组数据能正确预测未经治疗的 PPMS 患者的残疾进展和脑容量变化,这些患者可从早期治疗中获益。