临床孤立综合征转归相关因素分析Risk factors for clinically isolated syndromes converting into multiple sclerosis or neuromyelitis optica
罗家明;王莉;柯莎;周晶;余巨明;秦新月;
摘要(Abstract):
目的探讨临床孤立综合征(clinically isolated syndromes,CIS)转归为多发性硬化(multiple sclerosis,MS)和视神脊髓炎(neuromyelitis optica,NMO)的影响因素。方法收集CIS患者106例,据CIS转归结果分为MS组、NMO组和未转归组,以同年龄段健康体检人群100名作为健康对照,分析比较各组之间血清尿酸(uric acid,UA)和同型半胱氨酸(homocysteine,HCY)水平,以多因素回归分析方法分析CIS类型、年龄、性别、病灶数量、影像学特点、扩展的神经功能障碍评分(expanded disability status scale,EDSS)评分、HCY水平、UA水平、治疗是否使用糖皮质激素等因素与CIS转归为MS或NMO的关系。结果总体转归为MS共18例(16.98%),转归为NMO共38例(35.85%)。MS组〔(316.26±186.76)μmol/L〕与NMO组〔(323.95±218.64)μmol/L〕UA水平低于未转归组〔(495.22±259.57)μmol/L〕和健康对照组〔(581.34±283.88)μmol/L〕(P<0.05),MS组与NMO组比较,以及未转归组与健康对照组比较差异均无统计学意义(P≥0.05)。MS组HCY水平〔(21.30±12.92)μmol/L〕高于NMO组〔(9.65±4.31)μmol/L〕、未转归组〔(11.40±5.87)μmol/L〕及健康对照组〔(10.86±4.91)μmol/L〕(均P<0.05),NMO组、未转归组及健康对照组HCY水平差异无统计学意义(P≥0.05)。多因素回归分析结果提示女性(OR=8.945,P=0.043)、多病灶(OR=6.681,P=0.000)、EDSS评分高于平均值(OR=8.451,P=0.000)与和HCY水平高于平均值(OR=7.839,P=0.000)是CIS易于转归为MS的影响因素,而多病灶(OR=6.947,P=0.000)、UA水平低于平均值(OR=1.368,P=0.024)、初次发作EDSS评分高于平均值(OR=9.002,P=0.000)是CIS易于为NMO的影响因素。结论女性患者、多病灶特点、高HCY水平、EDSS评分高对CIS转归为MS有预测价值;多病灶特点、低血UA水平、EDSS评分高对CIS转归为NMO有预测价值。
关键词(KeyWords): 临床孤立综合征;多发性硬化;视神经脊髓炎;尿酸;同型半胱氨酸
基金项目(Foundation): 四川省卫生厅资助项目(110305)
作者(Author): 罗家明;王莉;柯莎;周晶;余巨明;秦新月;
Email:
DOI:
参考文献(References):
- [1]Miller DH,Chard DT,Ciccarelli O.Clinically isolated syndromes[J].Lancet Neurol,2012,11(2):157-169.
- [2]Miller D,Barkhof F,Montalban X,et al.Clinically isolated syndromes suggestive of multiple sclerosis,part I:natural history,pathogenesis,diagnosis,and prognosis[J].Lancet Neurol,2005,4(5):281-288.
- [3]Miller D,Barkhof F,Montalban X,et al.Clinically isolated syndromes suggestive of multiple sclerosis,part 2:non-conventional MRI,recovery processes,and management[J].Lancet Neurol,2005,4(6):341-348.
- [4]杨晓岚,陆钦池.临床孤立综合征转归及预后的研究[J].神经病学与神经康复学杂志,2009,6(2):1167-1169.
- [5]庄立.临床孤立综合征转化为多发性硬化的预测指标及治疗[J].中国神经免疫学和神经病学杂志,2010,17(4):290-293.
- [6]郭海霞,张美妮,郝洪军.临床孤立综合征转归为视神经脊髓炎的相关因素分析[J].中国神经免疫学和神经病学杂志,2012,19(5):354-357.
- [7]Wingerchuk D,Lennon V,Pittock S,et al.Revised diagnostic criteria for neuromyelitis optica[J].Neurology,2006,66(10):1485-1489.
- [8]Polman CH,Reingold SC,Edan G,et al.Diagnostic criteria for multiple sclerosis:2005revisions to the“McDonald Criteria”[J].Ann Neurol,2005,58(6):840-846.
- [9]Koch M,De Keyser J.Uric acid in multiple sclerosis[J].Neurol Res,2006,28(3):316-319.
- [10]Peng F,Zhang B,Zhong X,et al.Serum uric acid levels of patients with multiple sclerosis and other neurological diseases[J].Mult Scler,2008,14(2):188-196.
- [11]Scott GS,Spitsin SV,Kean RB,et al.Therapeutic intervention in experimental allergic encephalomyelitis by administration of uric acid precursors[J].Proc Natl Acad Sci USA,2002,99(25):16303-16308.
- [12]尤小凡,叶静,秦伟,等.视神经脊髓炎血清尿酸水平与临床相关性研究[J].中华内科杂志,2010,49(11):935-938.
- [13]Min JH,Waters P,Vincent A,et al.Reduced serum uric acid levels in neuromyelitis optica:serum uric acid levels are reduced during relapses in NMO[J].Acta Neurol Scand,2012,126(4):287-291.
- [14]Liu C,Xu Y,Cui L,et al.Serum uric acid levels and their correlation with clinical and cerebrospinal fluid parameters in patients with neuromyelitis optica[J].J Clin Neurosci,2013,20(2):278-280.
- [15]Sahin S,Aksungar FB,Topkaya AE,et al.Increased plasma homocysteine levels in multiple sclerosis[J].Mult Scler,2007,13(7):945-946.
- [16]Zhu Y,He ZY,Liu HN.Meta-analysis of the relationship between homocysteine,vitamin B(1)(2),folate,and multiple sclerosis[J].J Clin Neurosci,2011,18(7):933-938.
- [17]Blom HJ,Smulders Y.Overview of homocysteine and folate metabolism.With special references to cardiovascular disease and neural tube defects[J].J Inherit Metab Dis,2011,34(1):75-81.
- [18]Teunissen CE,Killestein J,Kragt JJ,et al.Serum homocysteine levels in relation to clinical progression in multiple sclerosis[J].J Neurol Neurosurg Psychiatry,2008,79(12):1349-1353.