多发性硬化和视神经脊髓炎谱系疾病脊髓萎缩与疾病严重程度相关性研究  

Study on the correlation between spinal cord atrophy and disease severity in multiple sclerosis and neuromyelitis optica spectrum disorders

作　　者：朱晓琴 段云云 卓芝政 孙君 田德财 张宁男楠 李郁欣 李坤成[5] 李咏梅[6] 韩雪梅[7] 黄木华 孙佳 刘亚欧 Zhu Xiaoqin;Duan Yunyun;Zhuo Zhizheng;Sun Jun;Tian Decai;Zhang Ningnannan;Li Yuxin;Li Kuncheng;Li Yongmei;Han Xuemei;Huang Muhua;Sun Jia;Liu Ya′ou(Department of Radiology,Beijing Tiantan Hospital,Capital Medical University,Beijing100070,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing100070,China;Department of Radiology and Tianjin Key Laboratory of Functional Imaging,Tianjin Medical University General Hospital,Tianjin300052,China;Department of Radiology,Huashan Hospital,Fudan University,Shanghai200040,China;Department of Radiology,Xuanwu Hospital,Capital Medical University,Beijing100053,China;Department of Radiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing400016,China;Department of Neurology,China-Japan Union Hospital of Jilin University,Changchun130031,China;Department of Radiology,the First Affiliated Hospital,Nanchang University,Nanchang330006,China)

机构地区：[1]首都医科大学附属北京天坛医院放射科,北京100070 [2]首都医科大学附属北京天坛医院神经病学中心,北京100070 [3]天津医科大学总医院放射科天津市功能影像重点实验室,天津300052 [4]复旦大学附属华山医院放射科,上海200040 [5]首都医科大学宣武医院放射科,北京100053 [6]重庆医科大学附属第一医院放射科,重庆400016 [7]吉林大学中日联谊医院第一神经内科,长春130031 [8]南昌大学附属第一医院放射科,南昌330006

出　　处：《中华放射学杂志》2025年第1期57-63,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(82330057)。

摘　　要：目的探讨多发性硬化(MS)和视神经脊髓炎谱系疾病(NMOSD)脊髓结构的改变及其与临床残疾之间的关系。方法该研究为横断面研究。回顾性分析2018年1月至2021年10月来自7个医疗中心的124例MS患者(MS组)、101例水通道蛋白4抗体阳性的NMOSD患者(NMOSD组)以及110名健康对照(HC组)的临床和影像学资料。所有受检者均接受3D T 1WI检查,分割并测量上颈髓平均横截面积(MUCCA)。所有受检者均完成了基线和随访的扩展残疾状态量表(EDSS)评分,以及基线25英尺步行实验(T25FW)和九孔钉测试(NHPT)。根据随访EDSS评分将患者分为EDSS进展和未进展。3组间的MUCCA比较使用协方差分析,将年龄和性别作为协变量予以控制,组间两两比较采用HSD检验。采用单因素线性回归、单变量logistic模型筛选预测MS组和NMOSD组基线临床残疾状态或EDSS进展的候选预测因子,采用L1正则化多因素线性回归分析预测基线临床残疾状态或EDSS进展独立预测因子。将独立预测因子联合建立logistic回归模型,采用受试者操作特征和曲线下面积(AUC)分析模型评估EDSS进展的效能。结果144例患者完成随访EDSS评分,随访时间3.30(1.10,6.42)年,其中MS组82例、NMOSD组62例。以性别和年龄作为协变量,MS组、NMOSD组、HC组MUCCA总体差异具有统计学意义(P=0.001),其中MS组的MUCCA小于HC组,差异具有统计学意义(t=-2.54,P=0.007);NMOSD组的MUCCA小于HC组,差异具有统计学意义(t=-2.80,P=0.002);MS组与NMOSD组MUCCA的差异无统计学意义(t=-0.40,P=0.882)。在MS组中,MUCCA是基线EDSS评分(β=-0.03)、基线T25FW评分(β=-0.09)和基线NHPT评分(β=-0.30)的独立预测因子。在NMOSD组中,MUCCA(β=-0.08)、年龄(β=0.06)、基线EDSS评分(β=-0.43)是EDSS进展的独立预测因子,三者构建的logistic回归模型预测EDSS进展的AUC为0.82。结论MS和NMOSD两种疾病患者脊髓均发生显著萎缩。上颈段脊髓萎缩能预测MS患者的残疾程�ObjectiveTo investigate the structural changes in the spinal cord in multiple sclerosis(MS)and neuromyelitis optica spectrum disorders(NMOSD)and their relationship with clinical disability.MethodsThis study was cross-sectional.A retrospective analysis of clinical and imaging data from 124 patients with MS(MS group),101 patients with aquaporin-4 antibody-positive NMOSD(NMOSD group),and 110 healthy controls(HC group)from seven medical centers were conducted from January 2018 to October 2021.All subjects underwent 3D T 1WI,and the upper cervical spinal cord cross-sectional area(MUCCA)was segmented and measured.All patients completed the expanded disability status scale(EDSS)assessments at baseline and during follow-up,as well as the baseline 25-foot walk test(T25FW)and the nine-hole peg test(NHPT).Patients were classified into EDSS progression and non-progression groups based on follow-up EDSS scores.Comparisons of MUCCA among the three groups were conducted using analysis of covariance,controlling for age and sex as covariates.Pairwise comparisons between groups were performed using the HSD test.Univariate linear regression and logistic models were employed to identify candidate predictors of baseline clinical disability status or EDSS progression in the MS and NMOSD groups.L1 regularized multivariable linear regression analysis was used to determine independent predictors of baseline clinical disability status or EDSS progression.Independent predictors were then combined to establish a logistic regression model,and the model′s performance in predicting EDSS progression was evaluated using receiver operating characteristic analysis and the area under the curve(AUC).ResultsA total of 144 patients completed follow-up EDSS assessments,with a follow-up duration of 3.30(1.10,6.42)years,including 82 patients in the MS group and 62 patients in the NMOSD group.Controlling for sex and age as covariates,the overall difference in MUCCA among the MS,NMOSD,and HC groups was statistically significant(P=0.001).The MUCCA in the

关 键 词：多发性硬化 脊髓 视神经脊髓炎谱系疾病 磁共振成像 

分 类 号：R74[医药卫生—神经病学与精神病学]