背景:多发性硬化症(MS)的个体间病程变化很大。这项研究的目的是研究无κ轻链(κ-FLC)指数和血清神经丝光(sNfL)是否对MS疾病活动具有累加预测价值。
方法:在发病时接受脑脊液(CSF)和血清采样的早期MS患者随访4年。在基线,年龄,性别,疾病持续时间,T2-高强度(T2L)的数量,并确定MRI上的对比增强T1病变(CEL)。随访期间,记录了第二次临床发作和开始疾病改善治疗(DMT)的发生.通过比浊法测量κ-FLC,κ-FLC指数计算为[CSFκ-FLC/血清κ-FLC]/白蛋白商。sNfL通过单分子阵列测定,并计算年龄和体重指数调整后的Z评分.
结果:共纳入86例患者,平均年龄33±10岁,女性占67%;36例(42%)患者在随访期间经历了第二次临床发作。Cox回归分析调整了年龄,性别,T2L,CEL,疾病和随访时间,随访期间使用DMT显示,κ-FLC指数和sNfLZ评分可独立预测第二次临床发作的时间。在高κ-FLC指数(>100)和高sNfLZ评分(>3)的患者中,12个月内无复发的机会为2%,高κ-FLC指数(>100)和低sNfLZ评分(≤3)的患者为30%,κ-FLC指数较低(≤100)但sNfLZ评分较高(>3)的患者占70%,90%患者的κ-FLC指数(≤100)和sNfLZ评分(≤3)较低。
结论:κ-FLC指数和sNfLZ评分对早期MS疾病活动具有附加预测价值,而与已知预测因子无关。
背景:这项研究由奥地利多发性硬化症协会慈善基金会资助。
BACKGROUND: Inter-individual courses of multiple sclerosis (MS) are extremely variable. The objective of this
study was to investigate whether κ-free light chain (κ-FLC) index and serum neurofilament light (sNfL) have an additive predictive value for MS disease activity.
METHODS: Patients with early MS who had cerebrospinal fluid (CSF) and serum sampling at disease onset were followed for four years. At baseline, age, sex, disease duration, number of T2-hyperintense (T2L), and contrast-enhancing T1 lesions (CEL) on MRI were determined. During follow-up, the occurrence of a second clinical attack and start of disease-modifying treatment (DMT) were registered. κ-FLC was measured by nephelometry, and κ-FLC index calculated as [CSF κ-FLC/serum κ-FLC]/albumin quotient. sNfL was determined by single-molecule array, and age- and body-mass-index adjusted Z scores were calculated.
RESULTS: A total of 86 patients at a mean age of 33 ± 10 years and with a female predominance of 67% were included; 36 (42%) patients experienced a second clinical attack during follow-up. Cox regression analysis adjusted for age, sex, T2L, CEL, disease and follow-up duration, and DMT use during follow-up revealed that both κ-FLC index as well as sNfL Z score independently predict time to second clinical attack. The chance for freedom of relapse within 12 months was 2% in patients with high levels of κ-FLC index (>100) and high sNfL Z score (>3), 30% in patients with high κ-FLC index (>100) and lower sNfL Z score (≤3), 70% in patients with lower κ-FLC index (≤100) but high sNfL Z score (>3), and 90% in patients with lower levels of κ-FLC index (≤100) and sNfL Z score (≤3).
CONCLUSIONS: κ-FLC index and sNfL Z score have an additive predictive value for early MS disease activity that is independent of known predictors.
BACKGROUND: This
study was funded by a grant of the charitable foundation of the Austrian Multiple Sclerosis Society.