多发性硬化SF-36的影响因素分析

目的探讨多发性硬化(MS)"健康调查简易量表"(SF-36)的影响因素。方法对比分析MS不同间歇期、发作期、Zung抑郁自评量表(SDS)评分指数、焦虑自评量表(SAS)评分、扩充神经功能残疾量表(EDSS)评分及病程等SF-36各维度,如生理功能(PF)、情感职能(RE)、社会功能(SF)、精神健康(MH)、生理职能(RP)、精力(VT)、躯体疼痛(BP)、总体健康(GH)等参数,提出MS者SF-36的影响因素。结果 MS患者间歇期越缩短、发作期及病程越延长、SDS及SAS和EDSS评分越高,SF-36各维度评分越降低(P0.05或P0.01)。结论间歇期、发作期、SDS评分指数、SAS及EDSS评分、病程等直接影响MS患者的生活质量。     

多发性硬化的治疗进展

传统观点认为多发性硬化（MS）是一种中枢神经系统的自身免疫性炎性脱髓鞘疾病,常采用免疫抑制和抗炎治疗。随着对MS发病机制研究的深入,许多新的治疗策略被用于MS的治疗。MS疾病修正治疗已尝试进行MS发病的特异性靶点治疗,而对进展性MS则采用神经保护和神经修复治疗。与当前的治疗措施相比,新的治疗方案对控制MS复发更有效,但也带来一定的风险。目前仍在积极寻找进展性MS的有效治疗手段。     

扩展致残量表评分对多发性硬化患者的预后分析

扩展致残量表(EDSS)是在致残量表(DSS)的基础上完善而成的。目前国际上用于多发性硬化(MS)患者神经系统各项功能的评价。本研究分析不同临床类型MS患者治疗前后的EDSS评分,以探讨在不同类型MS预后评估中的作用。1对象与方法1.1对象系1994年2月～2004年2月我院和山东大学齐鲁医院住院的、符合Poser诊断标准[1]的MS患者136例,男44例,女92例;年龄9～73岁,平均(35.9±11.4)岁;发病年龄9～69岁,平均(33.1±10.8)岁;病程20d～40年,平均(2.8±1.6)年。按照Lublin标准[2]分为复发缓解型85例(62.5%),原发进展型16例(11.8%),继发进展型18例(1…     

多发性硬化康复治疗

<正>多发性硬化(MS)是一种以中枢神经系统白质脱髓鞘为主要病理改变的自身免疫性疾病,常见病变部位位于脑或脊髓,临床表现为病变多发和反复复发-缓解病程,即空间和时间多发性,以髓鞘脱失、神经胶质增生、不同程度轴索病变和进行性神经功能障碍为主要特点,常累及脑室周围白质、视神经、脊髓、脑干和小脑,尤以侧脑室体部和脊髓前角多     

多发性硬化药物治疗进展

多发性硬化(multiple sclerosis,MS)是中枢神经系统(CNS)炎性脱髓鞘病变为特征的自身免疫性疾病。目前其治疗方案仍不成熟。此文就目前正在应用和研究的MS治疗药物进行综述。     

多发性硬化的免疫治疗研究

多发性硬化（multiplesclerosis，MS）及其动物模型实验性自身免疫性脑脊髓炎（experi－mentalautoimmuneencephalomyelitis，EAE）可能是神经系统的自身免疫性疾病，以神经系统的炎症、脱髓鞘和星形细胞增生为特征。近年来，对于其发病机制的研究进展较快，认为MS是一种主要由T细胞介导的免疫性疾病，一些炎症性细胞因子（cytokine，Ck）如IFNr、LT、TNFa、IL－1等在其发病中起重要作用，通过一些抑制剂来恢复这些炎性细胞因子的平衡似乎是一种可能治疗的途径。目前研究较多的主要包括两大类即Ck抑制剂和抑制性Ck。1Ck抑制剂Ck抑…     

多发性硬化的治疗进展

多发性硬化（MS）是一种常见的中枢神经系统自身免疫性炎性脱髓鞘疾病,自身抗原激活T细胞和B细胞介导的免疫机制异常在MS的致病过程中起重要作用。MS改良治疗（DMTs）可特异性作用于某个与致病机制相关的靶细胞或分子而发挥治疗作用,本文就近年口服药物和单克隆抗体治疗MS的新进展做一综述。     

多发性硬化的诊断

多发性硬化(multiple sclerosis,MS)是中枢神经系统炎性脱髓鞘疾病,好发于20～40岁,女性多见,其显著特点为时间上的多发性(多次发作)及空间上的多发性(多个病变部位),呈慢性发作性病程,晚期病情进展较快,是致残率较高的疾病,严重影响患者生活质量.近年来,新的免疫治疗药物如干扰素-β用于治疗MS,该药能降低MS的复发次数[1],特别是其用于临床孤立综合征(clinically isolated syndrome,CIS)能够降低CIS的临床确诊MS(clinically definite MS,CDMS)转化率[2].这些结果表明,早期诊断、早期治疗MS能够改善预后,而MS的早期正确诊断是核心.     

多发性硬化患者血清尿酸水平变化及与致残状况相关性研究

目的 探讨多发性硬化(MS)患者血清尿酸水平变化及其与致残状况的相关性.方法 收集复发缓解型多发性硬化患者42例,作为MS组,将MS组患者根据不同发作时期再分为MS-复发组和MS-缓解组;收集健康体检者42例作为对照组;比较MS与对照组间以及MS-复发组与MS-缓解组间血清尿酸水平,EDSS量表评价所有MS患者致残状况,对MS患者血清尿酸水平与EDSS评分进行相关性分析.结果 MS组血清尿酸浓度为(205.19±42.99) μmol/L,显著低于正常对照人群的(301.81±87.98) μmol/L,两组间比较差异有统计学意义(t=2.143,P＜0.05);MS组EDSS评分为(3.9±1.1)分,较正常人群表现出显著的功能障碍;MS-复发组血清尿酸浓度为(171.47±38.33)μmol/L,显著低于MS-缓解组的(238.91±47.64) μmol/L,两组间比较差异有统计学意义(t=1.917,P＜0.05);MS患者血清尿酸水平与其EDSS评分呈显著负相关(r=-0.365,P=0.011).结论 机体内尿酸水平的缺失在某种程度上可以影响多发性硬化的发生与进展,还与MS患者功能残障的发生及发展密切相关.     

多发性硬化患者病情演变与tau蛋白关系的研究

目的 探讨神经元损伤的标志物tau蛋白与多发性硬化患者病情演变的关系.方法 48例多发性硬化患者分为复发-缓解组和继发进展组,MSSS和EDSS量表评定疾病严重程度及致残状况.ELISA法测定患者脑脊液和血清总-tau(total-tau,T-tau)蛋白和磷酸化-tau(phospho-tau,P-tau)蛋白浓度.结果 复发-缓解组患者脑脊液T-tau蛋白浓度明显高于继发进展组(P=0.01).多发性硬化患者脑脊液T-tau蛋白与EDSS评分呈负相关(γ=-0.58,P=0.0006).结论 多发性硬化患者病程中脑脊液总tau蛋白浓度的变化,间接反映脑实质损伤的程度.     

肿瘤坏死因子α基因多态性与多发性硬化的相关性研究

目的:研究肿瘤坏死因子α(TNFα)基因多态性与多发性硬化(MS)的相关性。方法:①采用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)技术对58例MS患者和79名健康人进行TNFα基因多态性分析。②对MS组患者分别进行扩展病残状态评分(expanded disability status scale,EDSS)、首次发病年龄、病程、发病次数临床资料收集。结果:①MS组TNFα基因型分布及等位基因频率与正常对照组比较均无明显差异(χ2=0.466,P=0.495;χ2=0.229,P=0.632)。②基因型为TNFα1/1、TNFα1/2、TNFα2/2的EDSS评分、首次发病年龄、病程及发病次数各组间比较差异均无统计学意义(F=0.53,P=0.5914;F=1.34,P=0.2699;F=0.37,P=0.6914;F=0.49,P=0.6182)。结论:TNFα等位基因多态性与MS的易患性、EDSS评分、首次发病年龄、病程及发病次数均无显著相关性。     

EDSS correlated analysis of median nerve somatosensory evoked potentials in multiple sclerosis

Median nerve somatosensory evoked potentials (SEP) were recorded in 30 patients with multiple sclerosis. The examined patients had an expanded disability status scale (EDSS) between 0 and 6. The primary cortical potential N20, the subcortical potentials P14, N13b, N13a and the peripheral potential P9 were recorded simultaneously. In 5 patients normal SEP were observed (group 1) and in 6 patients there were consecutive disturbances of the somatosensory pathway (group 3). In 19 patients subcortical potentials were abnormal or absent while the following potentials were normal or identified which pattern corresponds to amplification within CNS structures (group 2). The EDSS of groups 1 and 2 were similar and lower than the EDSS of group 3, which indicates that amplification mechanisms could represent a positive prognostic factor in SEP diagnosis of multiple sclerosis. Received: 15 March 2000 / Accepted in revised form: 4 September 2000     

Hypermetabolism in multiple sclerosis patients

Hypermetabolism, which can lead to wasting syndrome, is well recognized in diseases such as AIDS, cancer, rheumatoid arthritis, sepsis and burns. In these conditions proinflammatory cytokines are thought to be essentially involved. In experimental allergic encephalitis (EAE), which is regarded as an animal model of multiple sclerosis (MS), wasting syndrome and elevated levels of cytokines have also been reported. The aim of this study was to investigate whether hypermetabolism does occur in MS patients. After a 3-day standard diet the basal metabolic rate (BMR) was measured by indirect calorimetry in 20 MS patients and 10 healthy controls. Body composition was assessed using an impedance analyser and lean body mass (LBM) was calculated. Other metabolic disturbances and infectious disease were ruled out by clinical examination and various laboratory tests. Tested by analysis of variance (ANOVA), the BMR corrected for LBM was increased by an average of 6% in the patients group (p < 0.05) as compared to the controls. As far as we know this is the first study demonstrating the presence of hypermetabolism in MS.     

Correlation between disability and transcranial magnetic stimulation abnormalities in patients with multiple sclerosis

Multiple sclerosis (MS) is an idiopathic inflammatory demyelinating disorder of the central nervous system. Clinical evaluation, MRI, cerebrospinal fluid testing and evoked potentials (EP) are among the available methods utilized for disease diagnosis and monitoring. To date, no surrogate markers have been established to assess disease evolution and progression. The aim of this study is to assess motor evoked potentials (MEP) of MS patients by transcranial magnetic stimulation (TMS) and investigate the possible correlations between TMS abnormalities and disability in the patient group, which includes a subgroup with no apparent pyramidal tract dysfunction. A total of 131 clinically definite MS patients were included in the study. Motor responses to TMS stimulation were recorded. Absent values, decreases in amplitude, prolongation of latency and central motor conduction time (CMCT) were considered as abnormal. A total of 109 (83%) patients displayed abnormal MEP amplitude, 68 (52%) displayed MEP latency, and 64 (49%) displayed CMCT abnormalities. Abnormal CMCT, latency and amplitude results were correlated with Expanded Disability Status Scale scores (p < 0.001). Our results indicate that TMS-EP in MS patients is correlated with disability, and that these findings may support the role of EPs in predicting disability even in subclinical presentations.     

Intrathecal versus systemic corticosteroids in the treatment of multiple sclerosis: results of a pilot study

Summary Fifty patients with multiple sclerosis were treated either by corticosteroids given systemically or by intrathecal injection of a steroid crystal suspension. Before and 3 weeks after the beginning of the treatment we examined the patients according to the Expanded Disability Status Scale (EDSS). Four patients had to be excluded from evaluation. In 23 patients the examination revealed at least a small improvement in their disability status. There were 7 intrathecally and 5 systemically treated patients whose disability was significantly reduced. One patient under intrathecal treatment showed a minor deterioration in disability. There was no clear difference in the frequency of improved symptoms or in EDSS scores between the two therapies.     

Early disturbances in multimodal evoked potentials as a prognostic factor for long-term disability in relapsing-remitting multiple sclerosis patients

Objective

The aim of this study was to investigate whether early alterations in evoked potentials (EPs) have a prognostic value in relapsing-remitting multiple sclerosis (RRMS).

Changes of the MS functional composite and EDSS during and after treatment of relapses with methylprednisolone in patients with multiple sclerosis

OBJECTIVES: The Multiple Sclerosis Functional Composite (MSFC) comprises quantitative functional measures of leg, hand/arm and cognitive function. We examined the responsiveness of the MSFC compared with the Expanded Disability Status Scale (EDSS) during treatment of relapses in patients with multiple sclerosis (MS). PATIENTS AND METHODS: 27 patients received 1000 mg intravenous methylprednisolone (i.v.-MP) for 5 days, followed by oral methylprednisolone for 14 days. The MSFC and the EDSS-score were assessed on day 0, before the first corticosteroid treatment, on day 5, after the last course of i.v. MP, and on day 20 after the treatment was finished. Before the first administration of the MSFC, patients were trained for the paced auditory addition test (PASAT) performing three test trials. In order to analyse practice effects, 10 MS patients without an acute exacerbation were tested three times under the same conditions as the treated group. RESULTS: The median EDSS-score was 2.5 in both groups. On day 5 it remained unchanged in all treated patients, on day 20 a decrease of 0.5 EDSS point occurred in five patients, and in two patients an improvement with a decrease of more than 0.5 point was observed. There was no statistically significant difference between the EDSS-scores on day 0, 5 and 20. The mean MSFC-score in the treated group was -0.14 +/- 0.63 on day 0, 0.17 +/- 0.66 on day 5, and 0.42 +/- 0.59 on day 20. On the last study day, 26 patients improved compared with day 0. The differences between the MSFC-scores at the three points of time were statistically significant for the treated group (P < 0.001), but not for the control group. CONCLUSION: During and after treatment of relapses in patients with MS, the MSFC appears to be more sensitive in detecting changes in function than the EDSS.     

Serial studies of serum interleukin-2 in chronic progressive multiple sclerosis patients: occurrence of ‘bursts’ and effect of cyclosporine

Serum levels of immunoreactive interleukin-2 (IL-2) were determined at monthly intervals from a group of placebo- and drug-treated chronic progressive multiple sclerosis patients before and during a cyclosporine A therapeutic trial. Significantly elevated levels of the lymphokine in active patients confirmed earlier studies. The magnitude of the initial levels varied inversely with the duration of disease and predicted subsequent worsening in chronic progressive patients. In addition, the occurrence of periodic bursts of serum IL-2 was noted. Although in some patients there appeared to be a sudden drop in serum IL-2 levels with the onset of cyclosporine A medication, no effect of this drug was noted on group analysis.     

Changes in LORETA and conventional patterns of P600 after steroid treatment in multiple sclerosis patients

OBJECTIVE: The P600 component of event-related potentials (ERPs) reflecting the 'rule-governed sequence of information processing', has been associated with multiple sclerosis (MS)-related cognition. The present study aimed at examining the effects of methylprednisolone treatment in MS patients on cognition as reflected by the low-resolution brain electromagnetic tomography (LORETA) of the P600 as well as its conventional constituents (amplitudes and latencies) recorded during a working memory (WM) test. METHOD: A paired LORETA comparison was performed in the P600 component of ERPs elicited during a (WM) test in 18 MS patients suffering from the relapsing-remitting form, before and after 1 week treatment with methylprednisolone. The P600 component was also evaluated in 16 healthy controls matched to the patients on age and educational level. RESULTS: When pre- and post-treatment recordings of LORETA were compared all patients as a group showed significantly different patterns of current density activation located at right frontal lobe. The treatment was accompanied by an increase of the amplitude of P600 at the right frontoparietal area. In the post-treatment phase the patients exhibited significant improvement of the memory performance as compared to themselves before treatment. As a result both the P600 amplitudes and memory performance at post-treatment were closer to those exhibited by normal controls. CONCLUSION: These findings support the notion that steroid treatment in relapsing-remitting MS patients, may exert a beneficial effect in 'rule-governed sequence of information processing'.